Healthcare Provider Details

I. General information

NPI: 1568974129
Provider Name (Legal Business Name): ADESUWA SARAH OHUOBA PMHNP-BC, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2017
Last Update Date: 09/29/2021
Certification Date: 09/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2831 SAINT ROSE PKWY STE 222
HENDERSON NV
89052-4840
US

IV. Provider business mailing address

20118 BANDERA LAKE LN
RICHMOND TX
77407-1569
US

V. Phone/Fax

Practice location:
  • Phone: 702-589-4871
  • Fax:
Mailing address:
  • Phone: 832-978-9787
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP135186
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: