Healthcare Provider Details

I. General information

NPI: 1497114466
Provider Name (Legal Business Name): BERNADINE UKEGBU-ANYADIKE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/18/2016
Last Update Date: 10/18/2021
Certification Date: 10/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4007 CRESTWIND LN
RICHMOND TX
77407-3222
US

IV. Provider business mailing address

4007 CRESTWIND LN
RICHMOND TX
77407-3222
US

V. Phone/Fax

Practice location:
  • Phone: 713-444-1655
  • Fax:
Mailing address:
  • Phone: 713-444-1655
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP129774
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP129774
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: