Healthcare Provider Details

I. General information

NPI: 1861939001
Provider Name (Legal Business Name): MERCY OKON FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/26/2017
Last Update Date: 01/26/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 CRAWFORD ST STE 210
HOUSTON TX
77002-8941
US

IV. Provider business mailing address

PO BOX 2393
SUGAR LAND TX
77487-2393
US

V. Phone/Fax

Practice location:
  • Phone: 713-951-0000
  • Fax:
Mailing address:
  • Phone: 346-400-6955
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP129968
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: