Healthcare Provider Details

I. General information

NPI: 1992379762
Provider Name (Legal Business Name): OGECHI UZOMAH PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2021
Last Update Date: 04/25/2023
Certification Date: 04/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2025 LAKE MOSS LN
LITTLE ELM TX
75068-1297
US

IV. Provider business mailing address

112 S PARK ST
SAN FRANCISCO CA
94107-1809
US

V. Phone/Fax

Practice location:
  • Phone: 469-531-4672
  • Fax:
Mailing address:
  • Phone: 855-249-3663
  • Fax: 855-249-6362

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number1038325
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: