Healthcare Provider Details

I. General information

NPI: 1699137133
Provider Name (Legal Business Name): KARIRI OBONYO FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2016
Last Update Date: 03/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14622 ROARING FORK LN
HOUSTON TX
77095-5244
US

IV. Provider business mailing address

14622 ROARING FORK LN
HOUSTON TX
77095-5244
US

V. Phone/Fax

Practice location:
  • Phone: 832-794-3659
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP130628
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: