Healthcare Provider Details

I. General information

NPI: 1376276618
Provider Name (Legal Business Name): SHONGERWI CHEKENYERE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2022
Last Update Date: 08/01/2023
Certification Date: 08/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 W TERRELL AVE
FORT WORTH TX
76104-3243
US

IV. Provider business mailing address

1708 BARDFIELD AVE
GARLAND TX
75041-4921
US

V. Phone/Fax

Practice location:
  • Phone: 817-702-3100
  • Fax: 817-702-4847
Mailing address:
  • Phone: 817-703-8313
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License Number954707
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number1130132
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number1130132
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: