Healthcare Provider Details

I. General information

NPI: 1023496726
Provider Name (Legal Business Name): ODIRI O AKUSHE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2015
Last Update Date: 08/03/2022
Certification Date: 08/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1727 LAKE CHARLOTTE LN
RICHMOND TX
77406-8096
US

IV. Provider business mailing address

1727 LAKE CHARLOTTE LN
RICHMOND TX
77406-8096
US

V. Phone/Fax

Practice location:
  • Phone: 832-584-4092
  • Fax:
Mailing address:
  • Phone: 832-584-4092
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP127791
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number697530
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number202006251NP-PP
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: