Healthcare Provider Details

I. General information

NPI: 1689039158
Provider Name (Legal Business Name): JENNIFER OGBEIDE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2015
Last Update Date: 03/04/2020
Certification Date: 03/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 W 7TH ST STE 121
FORT WORTH TX
76102-2651
US

IV. Provider business mailing address

1301 W 7TH ST STE 121
FORT WORTH TX
76102-2651
US

V. Phone/Fax

Practice location:
  • Phone: 817-348-0425
  • Fax: 817-348-0455
Mailing address:
  • Phone: 817-348-0425
  • Fax: 817-348-0455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP129876
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: