Provider Demographics
NPI:1902341084
Name:CAVANAUGH, EBONY (MSN, AGPCNP-BC, RN)
Entity Type:Individual
Prefix:
First Name:EBONY
Middle Name:
Last Name:CAVANAUGH
Suffix:
Gender:F
Credentials:MSN, AGPCNP-BC, RN
Other - Prefix:
Other - First Name:EBONY
Other - Middle Name:
Other - Last Name:CAVANAUGH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSN, AGPCNP-BC, RN
Mailing Address - Street 1:2552 PETTUS DR
Mailing Address - Street 2:
Mailing Address - City:FORNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75126-4158
Mailing Address - Country:US
Mailing Address - Phone:469-399-0380
Mailing Address - Fax:469-925-2137
Practice Address - Street 1:9696 SKILLMAN ST SUITE 220
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243
Practice Address - Country:US
Practice Address - Phone:469-399-0380
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-28
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP132893363LP2300X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health