Healthcare Provider Details

I. General information

NPI: 1093412199
Provider Name (Legal Business Name): VIVIAN N OKORIE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/09/2023
Last Update Date: 06/23/2023
Certification Date: 06/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 HILLCREST RD STE 185
FRISCO TX
75035-5401
US

IV. Provider business mailing address

4500 HILLCREST RD STE 185
FRISCO TX
75035-5401
US

V. Phone/Fax

Practice location:
  • Phone: 469-305-3390
  • Fax:
Mailing address:
  • Phone: 469-305-3390
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1053096
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: