Provider Demographics
NPI:1750758512
Name:DIBAKI, ATEMNKENG FONKEM (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:ATEMNKENG
Middle Name:FONKEM
Last Name:DIBAKI
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:318 W BELT LINE RD
Mailing Address - Street 2:
Mailing Address - City:CEDAR HILL
Mailing Address - State:TX
Mailing Address - Zip Code:75104-1104
Mailing Address - Country:US
Mailing Address - Phone:972-972-4767
Mailing Address - Fax:
Practice Address - Street 1:318 W BELT LINE RD STE 304
Practice Address - Street 2:
Practice Address - City:CEDAR HILL
Practice Address - State:TX
Practice Address - Zip Code:75104-1103
Practice Address - Country:US
Practice Address - Phone:972-972-4767
Practice Address - Fax:972-972-4737
Is Sole Proprietor?:No
Enumeration Date:2015-08-27
Last Update Date:2023-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP132256363LG0600X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology