Healthcare Provider Details

I. General information

NPI: 1881566719
Provider Name (Legal Business Name): BRIGETTE OBOKHAE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2025
Last Update Date: 10/08/2025
Certification Date: 10/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3500 SUNRISE HWY
GREAT RIVER NY
11739-1001
US

IV. Provider business mailing address

2113 WILDERNESS TRL
GRAND PRAIRIE TX
75052-1945
US

V. Phone/Fax

Practice location:
  • Phone: 469-300-1008
  • Fax:
Mailing address:
  • Phone: 469-300-1008
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: