Provider Demographics
NPI:1821838426
Name:AGBOTSE, ASEYE ABRA (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:ASEYE
Middle Name:ABRA
Last Name:AGBOTSE
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 1:2306 ALASSIO ISLE CT
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459-6976
Mailing Address - Country:US
Mailing Address - Phone:443-626-7073
Mailing Address - Fax:
Practice Address - Street 1:2306 ALASSIO ISLE CT
Practice Address - Street 2:
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77459-6976
Practice Address - Country:US
Practice Address - Phone:443-626-7073
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-30
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX959161163WG0000X
TX1155664163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice