Healthcare Provider Details

I. General information

NPI: 1235090747
Provider Name (Legal Business Name): EDITH OKOTIE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/24/2025
Last Update Date: 11/25/2025
Certification Date: 11/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4014 SUTTON SHADOW LN
KATY TX
77494-3785
US

IV. Provider business mailing address

4014 SUTTON SHADOW LN
KATY TX
77494-3785
US

V. Phone/Fax

Practice location:
  • Phone: 281-760-9158
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number1217829
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: