Healthcare Provider Details

I. General information

NPI: 1639789662
Provider Name (Legal Business Name): AUGUSTINA C OKORONKWO FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2020
Last Update Date: 11/09/2023
Certification Date: 11/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18906 HAYES GROVE LN
KATY TX
77449-1680
US

IV. Provider business mailing address

18906 HAYES GROVE LN
KATY TX
77449-1680
US

V. Phone/Fax

Practice location:
  • Phone: 713-298-3062
  • Fax:
Mailing address:
  • Phone: 713-298-3062
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1014587
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: