MEDICARE: BRENDA OCHIENG FNP

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	363LF0000X	Family Nurse Practitioner	138609	TX

General Provider Information

NPI Number	:	1346715315
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRENDA OCHIENG FNP

Provider Business Mailing Address
First Line	:	1217 GRAND AVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76164-9041
Country	:	US
Telephone Number	:	817-625-7733
Fax Number	:

Provider Business Practice Location Address
First Line	:	1217 GRAND AVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76164-9041
Country	:	US
Telephone Number	:	817-625-7733
Fax Number	:

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

Provider Enumeration Date	:	10/05/2018
Last Update Date	:	10/05/2018

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