Healthcare Provider Details

I. General information

NPI: 1386856946
Provider Name (Legal Business Name): CLEMENTINA O OKOYE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 01/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4807 OSAGE CT
ARLINGTON TX
76018-1072
US

IV. Provider business mailing address

4807 OSAGE CT
ARLINGTON TX
76018-1072
US

V. Phone/Fax

Practice location:
  • Phone: 817-793-2376
  • Fax: 817-784-9865
Mailing address:
  • Phone: 817-793-2376
  • Fax: 817-784-9865

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number009400
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: