Healthcare Provider Details

I. General information

NPI: 1154931376
Provider Name (Legal Business Name): CHINELO OKOLI NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2020
Last Update Date: 08/03/2020
Certification Date: 08/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 N CENTRAL EXPY STE 601
PLANO TX
75074-6771
US

IV. Provider business mailing address

13601 PINNACLE CIR W APT 2202
EULESS TX
76040-7666
US

V. Phone/Fax

Practice location:
  • Phone: 972-424-6311
  • Fax:
Mailing address:
  • Phone: 512-363-8885
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberAP143521
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: