Healthcare Provider Details

I. General information

NPI: 1083266274
Provider Name (Legal Business Name): CAROLYN OKONOFUA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2019
Last Update Date: 03/02/2021
Certification Date: 03/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3727 DILIDO RD STE 140
DALLAS TX
75228-5531
US

IV. Provider business mailing address

3727 DILIDO RD STE 140
DALLAS TX
75228-5531
US

V. Phone/Fax

Practice location:
  • Phone: 214-275-8898
  • Fax: 214-275-9986
Mailing address:
  • Phone: 214-275-8898
  • Fax: 214-275-9986

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP140241
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: