Healthcare Provider Details

I. General information

NPI: 1013718824
Provider Name (Legal Business Name): AGATHA IJEOMA OKORIE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2025
Last Update Date: 11/13/2025
Certification Date: 11/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14501 EMPANADA DR APT 912
HOUSTON TX
77083-3389
US

IV. Provider business mailing address

14501 EMPANADA DR APT 912
HOUSTON TX
77083-3389
US

V. Phone/Fax

Practice location:
  • Phone: 346-653-4257
  • Fax:
Mailing address:
  • Phone: 346-653-4257
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number0024194653
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number1067134
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number10019771
License Number StateOR
# 4
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP70036741
License Number StateWA
# 5
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number85432
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: