MEDICARE: EMMANUEL C OKOLO NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	AP141721	TX
2	363LF0000X	Family Nurse Practitioner	AP141721	TX

General Provider Information

NPI Number	:	1093363723
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMMANUEL C OKOLO NP

Provider Business Mailing Address
First Line	:	130 E BARDIN RD STE 108
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76018-1030
Country	:	US
Telephone Number	:	682-252-4386
Fax Number	:	817-583-7753

Provider Business Practice Location Address
First Line	:	130 E BARDIN RD STE 108
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76018-1030
Country	:	US
Telephone Number	:	682-252-4386
Fax Number	:	817-583-7753

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/27/2019
Last Update Date	:	07/29/2025

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