Healthcare Provider Details

I. General information

NPI: 1609187970
Provider Name (Legal Business Name): EVELYN OKUNOGHAE APRN, FNP-BC, DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2010
Last Update Date: 12/07/2021
Certification Date: 12/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9304 FOREST LN STE N177
DALLAS TX
75243-6238
US

IV. Provider business mailing address

9304 FOREST LN STE N177
DALLAS TX
75243-6238
US

V. Phone/Fax

Practice location:
  • Phone: 214-713-8228
  • Fax: 435-292-6684
Mailing address:
  • Phone: 214-713-8228
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP117057
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: