Healthcare Provider Details

I. General information

NPI: 1639063191
Provider Name (Legal Business Name): NKECHI VICTORIA NWAGBARA AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2025
Last Update Date: 06/10/2025
Certification Date: 06/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6320 SOUTHWEST BLVD STE 200
BENBROOK TX
76109-6961
US

IV. Provider business mailing address

3711 DR MLK JR DR APT 3404
ARLINGTON TX
76014-4347
US

V. Phone/Fax

Practice location:
  • Phone: 817-766-5500
  • Fax:
Mailing address:
  • Phone: 914-960-7925
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number81785
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: