Provider Demographics
NPI:1487044897
Name:MOEMENAM, ADAOBI (NP)
Entity Type:Individual
Prefix:
First Name:ADAOBI
Middle Name:
Last Name:MOEMENAM
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14821 BRETTRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:ALEDO
Mailing Address - State:TX
Mailing Address - Zip Code:76008-1437
Mailing Address - Country:US
Mailing Address - Phone:310-800-8445
Mailing Address - Fax:
Practice Address - Street 1:2006 FALL CREEK HWY
Practice Address - Street 2:
Practice Address - City:GRANBURY
Practice Address - State:TX
Practice Address - Zip Code:76049-7913
Practice Address - Country:US
Practice Address - Phone:817-326-3440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-24
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95000421363LF0000X
AZ293115363LF0000X, 363LP0808X
TXAP131032363LP0808X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health