Provider Demographics
NPI:1235962101
Name:KONADU, CLEMENT (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:CLEMENT
Middle Name:
Last Name:KONADU
Suffix:
Gender:M
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 SILVERWOOD TER
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76308-1424
Mailing Address - Country:US
Mailing Address - Phone:817-503-3566
Mailing Address - Fax:
Practice Address - Street 1:2 SILVERWOOD TER
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76308-1424
Practice Address - Country:US
Practice Address - Phone:817-503-3566
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-24
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1157733363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health