Provider Demographics
NPI:1134909450
Name:ASANTE-ANSONG, FIDELIA ADOMAKO (NP)
Entity type:Individual
Prefix:
First Name:FIDELIA
Middle Name:ADOMAKO
Last Name:ASANTE-ANSONG
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27922 COLONIAL POINT DR
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-3712
Mailing Address - Country:US
Mailing Address - Phone:703-732-1182
Mailing Address - Fax:
Practice Address - Street 1:27922 COLONIAL POINT DR
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-3712
Practice Address - Country:US
Practice Address - Phone:703-732-1182
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-03
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1138239363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health