Healthcare Provider Details

I. General information

NPI: 1518365030
Provider Name (Legal Business Name): MS. CAROLINE JOKOTOLA OGUNGBAYI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CAROLINE JOKOTOLA OGUNGBAYI NP-C

II. Dates (important events)

Enumeration Date: 12/16/2014
Last Update Date: 12/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12118 MEREWOOD LN
HOUSTON TX
77071-2416
US

IV. Provider business mailing address

12118 MEREWOOD LN
HOUSTON TX
77071-2416
US

V. Phone/Fax

Practice location:
  • Phone: 832-647-6565
  • Fax:
Mailing address:
  • Phone: 832-647-6565
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP127109
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: