MEDICARE: IFEOMA DIMKPA DNP FNP AANP-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	224Z00000X	Occupational Therapy Assistant	21154	TX
2	363LF0000X	Family Nurse Practitioner	1088418	TX

General Provider Information

NPI Number	:	1780961938
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IFEOMA DIMKPA DNP FNP AANP-BC

Provider Business Mailing Address
First Line	:	7338 ROUNDROCK PARK LN
Second Line	:
City	:	RICHMOND
State	:	TX
Zip	:	77407-1583
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1127 ELDRIDGE PKWY STE 200
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77077-1772
Country	:	US
Telephone Number	:	832-759-9277
Fax Number	:

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

Provider Enumeration Date	:	11/15/2011
Last Update Date	:	10/19/2022

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