Healthcare Provider Details

I. General information

NPI: 1659967792
Provider Name (Legal Business Name): AMORIGHOYE OTUBU FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/14/2020
Last Update Date: 03/14/2022
Certification Date: 03/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14723 W OAKS PLAZA DR APT 1023
HOUSTON TX
77082-3989
US

IV. Provider business mailing address

14723 W OAKS PLAZA DR
HOUSTON TX
77082-3974
US

V. Phone/Fax

Practice location:
  • Phone: 713-819-6477
  • Fax:
Mailing address:
  • Phone: 713-832-4477
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1020429
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: