Healthcare Provider Details

I. General information

NPI: 1457058554
Provider Name (Legal Business Name): JOY ONYEUGWOR FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JOY ONYEUGWOR FNP-C

II. Dates (important events)

Enumeration Date: 02/09/2023
Last Update Date: 05/01/2024
Certification Date: 05/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6029 BELT LINE RD STE 105
DALLAS TX
75254-7873
US

IV. Provider business mailing address

649 HUTCHINS DR
CROWLEY TX
76036-2749
US

V. Phone/Fax

Practice location:
  • Phone: 855-893-5637
  • Fax: 817-666-3873
Mailing address:
  • Phone: 817-703-5445
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number1110432
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1110432
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: