=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396111571
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHINEDU OKAFOR MSN, APRN, FNP-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/11/2015
-----------------------------------------------------
Last Update Date | 08/11/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 925 WRIGHT ST
-----------------------------------------------------
City | ARLINGTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76012-4731
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-801-5704
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7063 N SERRANO
-----------------------------------------------------
City | GRAND PRAIRIE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75054-6766
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-266-8583
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | AP127260
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------