Provider Demographics
NPI:1982489126
Name:BEDIAKO, STELLA A (PMHNP)
Entity Type:Individual
Prefix:
First Name:STELLA
Middle Name:A
Last Name:BEDIAKO
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:MS
Other - First Name:STELLA
Other - Middle Name:A
Other - Last Name:BEDIAKO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PMHNP
Mailing Address - Street 1:11868 TANGERINE LN
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75035-0023
Mailing Address - Country:US
Mailing Address - Phone:469-471-8078
Mailing Address - Fax:
Practice Address - Street 1:4500 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75069-1650
Practice Address - Country:US
Practice Address - Phone:972-547-8000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-28
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ295323363LP0808X
TX1126698363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health