Healthcare Provider Details

I. General information

NPI: 1205498524
Provider Name (Legal Business Name): UCHECHI MILLICENT OKORO PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2019
Last Update Date: 07/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 SUNSET AVE
DALLAS TX
75208-4606
US

IV. Provider business mailing address

3303 YORK DR
MANSFIELD TX
76063-4899
US

V. Phone/Fax

Practice location:
  • Phone: 214-941-3500
  • Fax:
Mailing address:
  • Phone: 817-262-0371
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP141990
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: