MEDICARE: CHINYERE JOY EGBUNA FNP, MD

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	AP127769	TX
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	AP127769	TX
3	390200000X	Student in an Organized Health Care Education/Training Program

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1811381262
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHINYERE JOY EGBUNA FNP, MD

Provider Business Mailing Address
First Line	:	1601 W 40TH AVE
Second Line	:
City	:	PINE BLUFF
State	:	AR
Zip	:	71603-6069
Country	:	US
Telephone Number	:	870-541-6010
Fax Number	:	870-541-6009

Provider Business Practice Location Address
First Line	:	1601 W 40TH AVE
Second Line	:
City	:	PINE BLUFF
State	:	AR
Zip	:	71603-6069
Country	:	US
Telephone Number	:	870-541-6010
Fax Number	:	870-541-6009

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

Provider Enumeration Date	:	03/24/2015
Last Update Date	:	03/19/2024

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