Healthcare Provider Details

I. General information

NPI: 1033725668
Provider Name (Legal Business Name): CHINYERE EMILIA OKONKWO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2020
Last Update Date: 08/25/2022
Certification Date: 08/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2436 S INTERSTATE 35 E STE 336
DENTON TX
76205-4900
US

IV. Provider business mailing address

303 S JUPITER RD STE 200
ALLEN TX
75002-3049
US

V. Phone/Fax

Practice location:
  • Phone: 940-484-7000
  • Fax:
Mailing address:
  • Phone: 972-747-0821
  • Fax: 972-747-9215

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1014043
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: