Healthcare Provider Details

I. General information

NPI: 1851406573
Provider Name (Legal Business Name): ANGELA I OKOTIE-EBOH N.P
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 04/30/2025
Certification Date: 04/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2420 FANNIN ST
HOUSTON TX
77002-9114
US

IV. Provider business mailing address

16520 STEINHAGEN RD
CYPRESS TX
77429-7173
US

V. Phone/Fax

Practice location:
  • Phone: 832-831-3651
  • Fax:
Mailing address:
  • Phone: 281-687-3413
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number643307
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number2011021217
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: