MEDICARE: MR. CHARLES EBERE OKPARA FNP-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
1	363LF0000X	Family Nurse Practitioner	778078	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	778075	OTHER	TX	BON

General Provider Information

NPI Number	:	1174187744
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CHARLES EBERE OKPARA FNP-BC

Provider Business Mailing Address
First Line	:	8016 STONEHILL DR
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75025-2564
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6409 PRESTON RD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75205-1610
Country	:	US
Telephone Number	:	602-909-8026
Fax Number	:

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

Provider Enumeration Date	:	04/29/2019
Last Update Date	:	12/19/2020

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