Doctor Name: | SHELMITH MAMO |
NPI Number: | 1194122341 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PMHNP |
License Number: | AP126843 |
Business Practice Address: | 5017 Heritage Ave Colleyville, TX - 760345994 |
Business Phone Number: | 8175459100 |
Business Fax Number: | |
Mailing Address: | 5017 Heritage Ave, COLLEYVILLE |
State: | TX |
Postal Code: | 760345994 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 12/02/2014 |
NPI Last Update Date: | 02/02/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LP0808X |
License Number: | AP126843 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TX |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Psych/Mental Health |
Taxonomy Definition: |