=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518893700
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHINONYEREM OGUNDU PMHNP-BC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/23/2026
-----------------------------------------------------
Last Update Date | 06/23/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1651 N COLLINS BLVD STE 240
-----------------------------------------------------
City | RICHARDSON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75080-3663
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-377-9166
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2139 MAIL AVE UNIT 103
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75235-3507
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 617-230-6433
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number | 1031987
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------