Provider Demographics
NPI:1770058927
Name:KEBEDE, BESRAT GEBREHIWOT
Entity type:Individual
Prefix:
First Name:BESRAT
Middle Name:GEBREHIWOT
Last Name:KEBEDE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13015 AUDELIA RD APT 12160
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-3165
Mailing Address - Country:US
Mailing Address - Phone:214-980-9163
Mailing Address - Fax:
Practice Address - Street 1:13015 AUDELIA RD APT 12160
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-3165
Practice Address - Country:US
Practice Address - Phone:214-980-9163
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-03
Last Update Date:2018-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX952940163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse