Healthcare Provider Details

I. General information

NPI: 1386978781
Provider Name (Legal Business Name): EVELYN EBERE UKADIKE NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2009
Last Update Date: 09/06/2022
Certification Date: 09/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12801 KEYSTONE DR
BALCH SPRINGS TX
75180
US

IV. Provider business mailing address

1105 E 32ND ST
JOPLIN MO
64804-2879
US

V. Phone/Fax

Practice location:
  • Phone: 469-878-6318
  • Fax: 214-772-6226
Mailing address:
  • Phone: 417-347-7600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number801108670
License Number StateTX
# 5
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number2022014834
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: