Provider Demographics
NPI:1902259815
Name:ABDELFETTAH, MALIKA (A/G NP)
Entity Type:Individual
Prefix:
First Name:MALIKA
Middle Name:
Last Name:ABDELFETTAH
Suffix:
Gender:F
Credentials:A/G NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6002 PACER LN
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76018-4038
Mailing Address - Country:US
Mailing Address - Phone:267-243-7709
Mailing Address - Fax:
Practice Address - Street 1:1919 S SHILOH RD
Practice Address - Street 2:SUITE 218
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75042-8234
Practice Address - Country:US
Practice Address - Phone:972-808-7541
Practice Address - Fax:972-808-7543
Is Sole Proprietor?:No
Enumeration Date:2016-07-14
Last Update Date:2016-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP130745363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner