Healthcare Provider Details

I. General information

NPI: 1649770165
Provider Name (Legal Business Name): BLESSING UCHECHUKWU SMITH PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BLESSING UCHECHUKWU ETUOKWU AGNP-C

II. Dates (important events)

Enumeration Date: 02/21/2018
Last Update Date: 06/26/2024
Certification Date: 06/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9711 S MASON RD STE 125-215
RICHMOND TX
77407-7167
US

IV. Provider business mailing address

9711 S MASON RD STE 125-215
RICHMOND TX
77407-7167
US

V. Phone/Fax

Practice location:
  • Phone: 346-933-2463
  • Fax: 713-234-7382
Mailing address:
  • Phone: 346-933-2463
  • Fax: 713-234-7382

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP139645
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: