Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 1050546 | TX |
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 65235 | NM |
NPI | 1013206838 |
---|---|
Provider Name | Mr. Raphael Mprah |
First Address | Arlington, TX 76002-4747 |
Second Address | Farmington, NM 87401-5638 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/04/2011 |
Last Update Date | 01/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
101320683 | (05) | NY |