MEDICARE: OGOMEGBUNAM CHINASA OGBONNA FNP, PMHNP

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
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	AP133763	TX
2	363LF0000X	Family Nurse Practitioner	AP133763	TX

General Provider Information

NPI Number	:	1134654528
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OGOMEGBUNAM CHINASA OGBONNA FNP, PMHNP

Provider Business Mailing Address
First Line	:	PO BOX 2603
Second Line	:
City	:	FT WORTH
State	:	TX
Zip	:	76113-2603
Country	:	US
Telephone Number	:	817-569-4300
Fax Number	:

Provider Business Practice Location Address
First Line	:	3840 HULEN ST
Second Line	:
City	:	FT WORTH
State	:	TX
Zip	:	76107-7277
Country	:	US
Telephone Number	:	817-335-3023
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/24/2017
Last Update Date	:	09/03/2025

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