MEDICARE: BENEDICTA AKAGHA

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	164W00000X	Licensed Practical Nurse	206647	TX

General Provider Information

NPI Number	:	1255835856
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BENEDICTA AKAGHA

Provider Business Mailing Address
First Line	:	17927 COLDALE GLEN LN
Second Line	:
City	:	RICHMOND
State	:	TX
Zip	:	77407-3374
Country	:	US
Telephone Number	:	832-259-5828
Fax Number	:

Provider Business Practice Location Address
First Line	:	17927 COLDALE GLEN LN
Second Line	:
City	:	RICHMOND
State	:	TX
Zip	:	77407-3374
Country	:	US
Telephone Number	:	832-259-5828
Fax Number	:

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

Provider Enumeration Date	:	03/20/2018
Last Update Date	:	03/20/2018

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