Individual
INNOCENT OMALE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
FNP
Contact information
Practice address
2900 HIGHWAY 121 STE 120, BEDFORD, TX 76021-4033
(817) 921-3000
Mailing address
1612 RIDGE HAVEN DR, 412, ARLINGTON, TX 76011-9061
(469) 684-2022
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
AP136144
TX
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
AP136144
TX
Other
Enumeration date
02/14/2018
Last updated
08/02/2021
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