Healthcare Provider Details

I. General information

NPI: 1396637393
Provider Name (Legal Business Name): CHIOMA OKOROAFOR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2025
Last Update Date: 07/16/2025
Certification Date: 07/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1125 N COLLEGE AVE
FAYETTEVILLE AR
72703-1908
US

IV. Provider business mailing address

226 S HILL AVE APT 109
FAYETTEVILLE AR
72701-5770
US

V. Phone/Fax

Practice location:
  • Phone: 479-713-8000
  • Fax:
Mailing address:
  • Phone: 479-445-4071
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: