Provider Demographics
NPI:1952417180
Name:ANTAI-OTONG, DEBORAH YVONNE (APRN, BC)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:YVONNE
Last Name:ANTAI-OTONG
Suffix:
Gender:F
Credentials:APRN, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2301 E LAMAR BLVD
Mailing Address - Street 2:SUITE 650
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76006-7415
Mailing Address - Country:US
Mailing Address - Phone:817-385-3794
Mailing Address - Fax:817-385-3700
Practice Address - Street 1:6000 WESTERN PL
Practice Address - Street 2:SUITE 300
Practice Address - City:FT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-4607
Practice Address - Country:US
Practice Address - Phone:817-530-2230
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX226422363LP0808X, 364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Not Answered364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult