Healthcare Provider Details

I. General information

NPI: 1972195840
Provider Name (Legal Business Name): NKEM OKOLI PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/11/2021
Last Update Date: 06/13/2022
Certification Date: 06/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1015 W CENTERVILLE RD STE 118
GARLAND TX
75041-5929
US

IV. Provider business mailing address

20119 GOSS HOLLOW LN
KATY TX
77449-0039
US

V. Phone/Fax

Practice location:
  • Phone: 972-807-6016
  • Fax:
Mailing address:
  • Phone: 240-351-7546
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number202112094NP
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number1019599
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: