Healthcare Provider Details

I. General information

NPI: 1215669288
Provider Name (Legal Business Name): IFEOMA UKAMAKA OMALIKO APRN, PMHNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2022
Last Update Date: 12/29/2022
Certification Date: 12/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9711 S MASON RD
RICHMOND TX
77407-7167
US

IV. Provider business mailing address

9711 S MASON RD STE 125
RICHMOND TX
77407-7169
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number1073759
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: