Healthcare Provider Details

I. General information

NPI: 1184264277
Provider Name (Legal Business Name): FAITH I OGALA PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/07/2020
Last Update Date: 07/18/2024
Certification Date: 07/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8035 E R L THORNTON FWY # 334
DALLAS TX
75228-7018
US

IV. Provider business mailing address

8035 E R L THORNTON FWY STE 334
DALLAS TX
75228-7018
US

V. Phone/Fax

Practice location:
  • Phone: 888-550-4842
  • Fax: 888-550-3391
Mailing address:
  • Phone: 888-550-4842
  • Fax: 888-550-3391

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License Number402953
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License Number95017454
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License Number209021104
License Number StateIL
# 4
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP144232
License Number StateTX
# 5
Primary TaxonomyN
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License NumberAP144232
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: