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NPI Code Detail

MEDICARE: CHRISTIANA UPE OMODUGBA-UDEH PMHNP-BC

MEDICARE: CHRISTIANA UPE OMODUGBA-UDEH PMHNP-BC
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
1363LP0808XPsychiatric/Mental Health Nurse Practitioner2022026825TX

General Provider Information

NPI Number : 1396456174
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHRISTIANA UPE OMODUGBA-UDEH PMHNP-BC
Provider Business Mailing Address
First Line : 13355 NOEL RD STE 1100
Second Line :
City : DALLAS
State : TX
Zip : 75240-6694
Country : US
Telephone Number : 833-400-0120
Fax Number :
Provider Business Practice Location Address
First Line : 13355 NOEL RD STE 1100
Second Line :
City : DALLAS
State : TX
Zip : 75240-6694
Country : US
Telephone Number : 833-400-0120
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/12/2022
Last Update Date : 06/01/2026

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