Healthcare Provider Details

I. General information

NPI: 1972484897
Provider Name (Legal Business Name): EVELYN AGU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2025
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3417 U OF A WAY
TEXARKANA AR
71854-1419
US

IV. Provider business mailing address

1105 VALLEY VISTA DR
IRVING TX
75063-9395
US

V. Phone/Fax

Practice location:
  • Phone: 903-293-7079
  • Fax: 870-779-6050
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberP137524
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: