| Elite Psychiatry Pc | |
|
3901 Arlington Highlands Blvd Ste 200 Arlington TX 76018-6050 | |
| (817) 695-5035 | |
| (817) 695-5037 |
| Full Name | Elite Psychiatry Pc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 3901 Arlington Highlands Blvd Ste 200, Arlington, Texas |
| Authorized Official Name and Position | Raven Elliott Modisette (C.E.O) |
| Authorized Official Contact | 8176955035 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Elite Psychiatry Pc 3901 Arlington Highlands Blvd Ste 200 Arlington TX 76018-6050 Ph: (817) 695-5035 | Elite Psychiatry Pc 3901 Arlington Highlands Blvd Ste 200 Arlington TX 76018-6050 Ph: (817) 695-5035 |
| NPI Number | 1952888265 |
|---|---|
| Provider Enumeration Date | 07/20/2018 |
| Last Update Date | 05/16/2020 |
| Certification Date | 05/16/2020 |
| Medicare PECOS PAC ID | 7214289388 |
|---|---|
| Medicare Enrollment ID | O20181018000272 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1952888265 | NPI | - | NPPES |
| M9770 | Other | TX | TX MEDICAL BOARD |
| AP137299 | Other | TX | APRN LICENSE NUMBER |
| Provider Name | Ayodele A Abraham |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1437378999 PECOS PAC ID: 8123166006 Enrollment ID: I20140204001221 |
| Provider Name | Raven Modisette |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1225580293 PECOS PAC ID: 5193080067 Enrollment ID: I20180523002511 |
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