Healthcare Provider Details

I. General information

NPI: 1235073065
Provider Name (Legal Business Name): CHINENYE NWOKENAKA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2026
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 SAN GABRIEL ST
AUSTIN TX
78705-4714
US

IV. Provider business mailing address

2719 FRESH DAWN DRIVE
FRESNO TX
77545
US

V. Phone/Fax

Practice location:
  • Phone: 866-508-2684
  • Fax:
Mailing address:
  • Phone: 866-508-2684
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: