MEDICARE: BERNADINE UKEGBU-ANYADIKE

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	AP129774	TX
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	AP129774	TX

General Provider Information

NPI Number	:	1497114466
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BERNADINE UKEGBU-ANYADIKE

Provider Business Mailing Address
First Line	:	4007 CRESTWIND LN
Second Line	:
City	:	RICHMOND
State	:	TX
Zip	:	77407-3222
Country	:	US
Telephone Number	:	713-444-1655
Fax Number	:

Provider Business Practice Location Address
First Line	:	4007 CRESTWIND LN
Second Line	:
City	:	RICHMOND
State	:	TX
Zip	:	77407-3222
Country	:	US
Telephone Number	:	713-444-1655
Fax Number	:

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

Provider Enumeration Date	:	02/18/2016
Last Update Date	:	10/18/2021

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