MEDICARE: CHIMA UDUMA

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	1190308	TX

General Provider Information

NPI Number	:	1386444735
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHIMA UDUMA

Provider Business Mailing Address
First Line	:	3939 W GREEN OAKS BLVD STE 202
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76016-2793
Country	:	US
Telephone Number	:	817-984-8804
Fax Number	:	817-803-6765

Provider Business Practice Location Address
First Line	:	9308 BALI DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76123-2986
Country	:	US
Telephone Number	:	443-425-8592
Fax Number	:

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

Provider Enumeration Date	:	03/15/2025
Last Update Date	:	10/08/2025

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