Healthcare Provider Details

I. General information

NPI: 1003686858
Provider Name (Legal Business Name): PEACE ISHMAEL BOSIRE OKIENYA DNP, APRN, PMHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/03/2024
Last Update Date: 01/25/2025
Certification Date: 01/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2911 TURTLE CREEK BLVD STE 300
DALLAS TX
75219-6243
US

IV. Provider business mailing address

621 AVENUE G
DALLAS TX
75203-3901
US

V. Phone/Fax

Practice location:
  • Phone: 214-518-2035
  • Fax: 972-803-3431
Mailing address:
  • Phone: 214-866-9270
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number1141765
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code2084B0040X
TaxonomyBehavioral Neurology & Neuropsychiatry Physician
License Number1141765
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: