Healthcare Provider Details

I. General information

NPI: 1659897130
Provider Name (Legal Business Name): NKEM AGATHA NWAOBI DNP, FNP-C, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2017
Last Update Date: 11/02/2024
Certification Date: 11/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6960 RENO CIRCLE
BEAUMONT TX
77708-3593
US

IV. Provider business mailing address

6960 RENO CIR
BEAUMONT TX
77708-3593
US

V. Phone/Fax

Practice location:
  • Phone: 409-234-9888
  • Fax:
Mailing address:
  • Phone: 409-924-0275
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP134846
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP134846
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: