Healthcare Provider Details

I. General information

NPI: 1669953816
Provider Name (Legal Business Name): CHRISTIAN CHIDOZIE OKOLOEDO NP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2018
Last Update Date: 10/02/2022
Certification Date: 10/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14141 SOUTHWEST FWY STE 500
SUGAR LAND TX
77478-3494
US

IV. Provider business mailing address

4419 HIDDEN OAKS WAY
HOUSTON TX
77084-7397
US

V. Phone/Fax

Practice location:
  • Phone: 281-356-0364
  • Fax:
Mailing address:
  • Phone: 832-343-5016
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number848154
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number848154
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number848154
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: