Healthcare Provider Details

I. General information

NPI: 1063063253
Provider Name (Legal Business Name): LOVETTE OKOH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2019
Last Update Date: 09/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8915 HARRY HINES BLVD
DALLAS TX
75235-1717
US

IV. Provider business mailing address

14145 NOEL RD APT 112
DALLAS TX
75254-4337
US

V. Phone/Fax

Practice location:
  • Phone: 214-956-3525
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number903194
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: