Healthcare Provider Details

I. General information

NPI: 1447547526
Provider Name (Legal Business Name): JENNIFER OBODOECHINA FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2011
Last Update Date: 02/10/2025
Certification Date: 02/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 HOLCOMBE
HOUSTON TX
77030-4009
US

IV. Provider business mailing address

P O BOX 4439
HOUSTON TX
77210-4439
US

V. Phone/Fax

Practice location:
  • Phone: 713-792-6161
  • Fax:
Mailing address:
  • Phone: 713-792-2991
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number726454
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number726454
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number726454
License Number StateTX
# 4
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAP119809
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: