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NPI Code Detail

MEDICARE: DR. PEACE ISHMAEL BOSIRE OKIENYA DNP, APRN, PMHNP-BC

MEDICARE: DR. PEACE ISHMAEL BOSIRE OKIENYA DNP, APRN, PMHNP-BC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LP0808XPsychiatric/Mental Health Nurse Practitioner1141765TX
22084B0040XBehavioral Neurology & Neuropsychiatry Physician1141765TX

General Provider Information

NPI Number : 1003686858
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. PEACE ISHMAEL BOSIRE OKIENYA DNP, APRN, PMHNP-BC
Provider Business Mailing Address
First Line : 621 AVENUE G
Second Line :
City : DALLAS
State : TX
Zip : 75203-3901
Country : US
Telephone Number : 214-866-9270
Fax Number :
Provider Business Practice Location Address
First Line : 2911 TURTLE CREEK BLVD STE 300
Second Line :
City : DALLAS
State : TX
Zip : 75219-6243
Country : US
Telephone Number : 214-518-2035
Fax Number : 972-803-3431
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/03/2024
Last Update Date : 01/25/2025

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