Provider Demographics
NPI:1558446997
Name:YEBOAH, PAUL (CRNA)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:YEBOAH
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6233 LOVE DRIVE APT 232
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TN
Mailing Address - Zip Code:75039
Mailing Address - Country:US
Mailing Address - Phone:972-681-7246
Mailing Address - Fax:972-681-8946
Practice Address - Street 1:3500 INTERSTATE 30
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TN
Practice Address - Zip Code:75150
Practice Address - Country:US
Practice Address - Phone:972-681-7246
Practice Address - Fax:972-681-8946
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX722797367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered