Healthcare Provider Details

I. General information

NPI: 1528621323
Provider Name (Legal Business Name): TRACEY ONYINYECHUKWU OKWARA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2019
Last Update Date: 08/29/2024
Certification Date: 08/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 UNIVERSITY BLVD
GALVESTON TX
77555-0193
US

IV. Provider business mailing address

301 UNIVERSITY BLVD
GALVESTON TX
77555-0193
US

V. Phone/Fax

Practice location:
  • Phone: 409-772-0770
  • Fax: 409-747-4010
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberT0119
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberBP10067761
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: