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NPI Code Detail

MEDICARE: FIDELIS UBONG IBE PMHNP

MEDICARE: FIDELIS UBONG IBE 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
1363LP0808XPsychiatric/Mental Health Nurse Practitioner1129412TX
2363LF0000XFamily Nurse Practitioner1129412TX

General Provider Information

NPI Number : 1780548529
Entity Type Code : Individual
Provider Name (Legal Business Name) : FIDELIS UBONG IBE PMHNP
Provider Business Mailing Address
First Line : 4801 WOODWAY DR STE 306W
Second Line :
City : HOUSTON
State : TX
Zip : 77056-1828
Country : US
Telephone Number : 832-225-3345
Fax Number : 713-583-1504
Provider Business Practice Location Address
First Line : 4801 WOODWAY DR STE 306W
Second Line :
City : HOUSTON
State : TX
Zip : 77056-1828
Country : US
Telephone Number : 832-225-3345
Fax Number : 713-583-1504
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/15/2025
Last Update Date : 04/13/2026

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