Provider Demographics
NPI:1972990612
Name:KAMARA, FANTA (NP)
Entity Type:Individual
Prefix:
First Name:FANTA
Middle Name:
Last Name:KAMARA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:FANTA
Other - Middle Name:
Other - Last Name:NABE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:2221 8TH AVE
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76110-1812
Mailing Address - Country:US
Mailing Address - Phone:817-336-5060
Mailing Address - Fax:817-336-1744
Practice Address - Street 1:2221 8TH AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76110-1812
Practice Address - Country:US
Practice Address - Phone:817-336-5060
Practice Address - Fax:817-336-1744
Is Sole Proprietor?:No
Enumeration Date:2015-04-21
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP144310363LF0000X
OH412518163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health