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General NPI Number Information
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NPI Number | 1275939761
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Entity Type | Individual
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Provider Name | IYEN OMORAGBON FNP
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Gender | Male
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Dates
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Enumeration Date | 11/10/2014
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Last Update Date | 07/24/2023
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Provider Practice Location Address
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Address Line | 4157 BEDFORD RD STE 200
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City | BEDFORD
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State | TX
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Zip | 76021-5228
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Country | US
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Telephone | 469-949-6080
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Fax | 972-634-1038
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Provider Business Mailing Address
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Address Line | 120 E FM 544 STE 72
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City | MURPHY
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State | TX
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Zip | 75094-4035
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Country | US
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Telephone | 469-949-6080
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Fax | 972-634-1038
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | AP126757
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License Number State | TX
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