Healthcare Provider Details

I. General information

NPI: 1093363723
Provider Name (Legal Business Name): EMMANUEL C OKOLO NP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2019
Last Update Date: 07/29/2025
Certification Date: 07/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 E BARDIN RD STE 108
ARLINGTON TX
76018-1030
US

IV. Provider business mailing address

130 E BARDIN RD STE 108
ARLINGTON TX
76018-1030
US

V. Phone/Fax

Practice location:
  • Phone: 682-252-4386
  • Fax: 817-583-7753
Mailing address:
  • Phone: 682-252-4386
  • Fax: 817-583-7753

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP141721
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP141721
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: