Healthcare Provider Details

I. General information

NPI: 1386515104
Provider Name (Legal Business Name): AUGUSTA ADAEZE OKPARA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2025
Last Update Date: 09/15/2025
Certification Date: 09/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

158 MARGARET AVE
DALLAS TX
75207-4069
US

IV. Provider business mailing address

158 MARGARET AVE
DALLAS TX
75207-4069
US

V. Phone/Fax

Practice location:
  • Phone: 216-376-0653
  • Fax:
Mailing address:
  • Phone: 216-376-0653
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number972441
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number972441
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number972441
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number972441
License Number StateTX
# 5
Primary TaxonomyN
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number972441
License Number StateTX
# 6
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number972441
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: