Healthcare Provider Details

I. General information

NPI: 1174879332
Provider Name (Legal Business Name): IRENE OKORONKWO NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2012
Last Update Date: 04/01/2024
Certification Date: 04/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5757 WOODWAY DR
HOUSTON TX
77057-1514
US

IV. Provider business mailing address

350 EL MOLINO BLVD
LAS CRUCES NM
88005-2915
US

V. Phone/Fax

Practice location:
  • Phone: 832-778-6750
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number745507
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP122083
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: