Provider Demographics
NPI:1700573300
Name:AWOSOGA, JEAN OSAS (PMHNP)
Entity Type:Individual
Prefix:MRS
First Name:JEAN
Middle Name:OSAS
Last Name:AWOSOGA
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 KNOLLWOOD RD
Mailing Address - Street 2:
Mailing Address - City:WYLIE
Mailing Address - State:TX
Mailing Address - Zip Code:75098-0346
Mailing Address - Country:US
Mailing Address - Phone:469-396-6617
Mailing Address - Fax:
Practice Address - Street 1:1701 KNOLLWOOD RD
Practice Address - Street 2:
Practice Address - City:WYLIE
Practice Address - State:TX
Practice Address - Zip Code:75098-0346
Practice Address - Country:US
Practice Address - Phone:469-396-6617
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-24
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1124023363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health