Healthcare Provider Details

I. General information

NPI: 1689191108
Provider Name (Legal Business Name): CHIZOBA USUWA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2017
Last Update Date: 09/30/2025
Certification Date: 09/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2313 W 28TH AVE
PINE BLUFF AR
71603-5049
US

IV. Provider business mailing address

2313 W 28TH AVE
PINE BLUFF AR
71603-5049
US

V. Phone/Fax

Practice location:
  • Phone: 870-895-5385
  • Fax: 440-596-4547
Mailing address:
  • Phone: 870-895-5385
  • Fax: 440-596-4547

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2017020541
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberE-15827
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: