Healthcare Provider Details

I. General information

NPI: 1225593429
Provider Name (Legal Business Name): CHRISTY AMANDA OBIAGERI OGBUEHI AGNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/01/2019
Last Update Date: 02/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8008 RICE DR
ROWLETT TX
75088-6698
US

IV. Provider business mailing address

8008 RICE DR # 8008
ROWLETT TX
75088-6698
US

V. Phone/Fax

Practice location:
  • Phone: 469-222-8605
  • Fax:
Mailing address:
  • Phone: 469-222-8605
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAP140058
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAP140058
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: