Provider Demographics
NPI:1336347954
Name:ISA, YAMAMAH MOHAMMAD (WHCNP)
Entity Type:Individual
Prefix:
First Name:YAMAMAH
Middle Name:MOHAMMAD
Last Name:ISA
Suffix:
Gender:F
Credentials:WHCNP
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 660599
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75266-0599
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8224 PARK LN STE 130
Practice Address - Street 2:VICKERY HEALTH CENTER
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-6021
Practice Address - Country:US
Practice Address - Phone:214-266-0350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-05
Last Update Date:2009-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX654555363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX196040308Medicaid
TX196040305Medicaid
TX196040309Medicaid
TX196040306Medicaid
TX196040307Medicaid
TX196040310Medicaid
TX196040301Medicaid
TX196040303Medicaid
TX196040302Medicaid
TX8Y2336OtherBLUE CROSS BLUE SHIELD