Healthcare Provider Details

I. General information

NPI: 1326516857
Provider Name (Legal Business Name): OBIAGERI OBY OKOROAFOR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2018
Last Update Date: 08/24/2020
Certification Date: 08/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7518 CENTENARY DR
ROWLETT TX
75089-3068
US

IV. Provider business mailing address

7518 CENTENARY DR
ROWLETT TX
75089-3068
US

V. Phone/Fax

Practice location:
  • Phone: 214-498-2431
  • Fax:
Mailing address:
  • Phone: 214-498-2431
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number731606
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP146003
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: