Provider Demographics
NPI:1679891030
Name:AGBEBAKU, BEATRICE O (APRN)
Entity Type:Individual
Prefix:MRS
First Name:BEATRICE
Middle Name:O
Last Name:AGBEBAKU
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9603 NEW KENT DR
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77498-1039
Mailing Address - Country:US
Mailing Address - Phone:210-310-9644
Mailing Address - Fax:
Practice Address - Street 1:7739 FALCON OAK DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78249
Practice Address - Country:US
Practice Address - Phone:210-310-9644
Practice Address - Fax:210-949-0281
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-11
Last Update Date:2019-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX758888372500000X, 163W00000X
TXAP140088363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered Nurse
No372500000XNursing Service Related ProvidersChore ProviderGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty