Provider Demographics
NPI:1750634002
Name:AHOUNOU, JOANNA N (PMHNP)
Entity Type:Individual
Prefix:MRS
First Name:JOANNA
Middle Name:N
Last Name:AHOUNOU
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 54455
Mailing Address - Street 2:
Mailing Address - City:HURST
Mailing Address - State:TX
Mailing Address - Zip Code:76054-4455
Mailing Address - Country:US
Mailing Address - Phone:817-679-0133
Mailing Address - Fax:
Practice Address - Street 1:3109 6TH AVE
Practice Address - Street 2:SUITE B
Practice Address - City:FT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76110-3800
Practice Address - Country:US
Practice Address - Phone:682-312-7339
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-24
Last Update Date:2016-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX692426363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX315192004Medicaid
TX273200Medicare PIN
TX273203Medicare PIN
TX273201Medicare PIN
TX334854Medicare PIN