Provider Demographics
NPI:1932734225
Name:BETHESDA FAMILY PRACTICE LLC
Entity type:Organization
Organization Name:BETHESDA FAMILY PRACTICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:MS
Authorized Official - First Name:KEHINDE
Authorized Official - Middle Name:R
Authorized Official - Last Name:AMOSUN
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:214-395-8659
Mailing Address - Street 1:3101 WILLOW CREEK CT
Mailing Address - Street 2:
Mailing Address - City:NORTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76226-4061
Mailing Address - Country:US
Mailing Address - Phone:214-395-8659
Mailing Address - Fax:833-966-2321
Practice Address - Street 1:3101 WILLOW CREEK CT
Practice Address - Street 2:
Practice Address - City:NORTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76226-4061
Practice Address - Country:US
Practice Address - Phone:214-395-8659
Practice Address - Fax:833-966-2321
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-06
Last Update Date:2025-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX08875754OtherDIVERS LICENSE