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General NPI Number Information
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NPI Number | 1225363906
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Entity Type | Individual
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Provider Name | OWEN O OMORAGBON NP
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Gender | Male
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Dates
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Enumeration Date | 10/13/2009
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Last Update Date | 11/23/2019
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Provider Practice Location Address
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Address Line | 1230 RIVER BEND DR STE 105
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City | DALLAS
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State | TX
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Zip | 75247-4916
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Country | US
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Telephone | 972-559-8003
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Fax |
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Provider Business Mailing Address
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Address Line | 1230 RIVER BEND DR STE 105
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City | DALLAS
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State | TX
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Zip | 75247-4916
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Country | US
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Telephone | 972-559-8003
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 010877
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | AP127005
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License Number State | TX
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