Provider Demographics
NPI:1841773504
Name:ABEGUNDE, ABRAHAM (APRN (PMHNP))
Entity Type:Individual
Prefix:
First Name:ABRAHAM
Middle Name:
Last Name:ABEGUNDE
Suffix:
Gender:M
Credentials:APRN (PMHNP)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7204 RUSTIC ROCK RD
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76001-6678
Mailing Address - Country:US
Mailing Address - Phone:702-349-2866
Mailing Address - Fax:
Practice Address - Street 1:7204 RUSTIC ROCK RD
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76001-6678
Practice Address - Country:US
Practice Address - Phone:702-349-2866
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-10
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1034518363LP0808X, 363LP0808X
TX884875163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0200XNursing Service ProvidersRegistered NursePediatrics