MEDICARE: LINDA OCHIENG

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	363A00000X	Physician Assistant	PA09405	TX

General Provider Information

NPI Number	:	1851769095
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LINDA OCHIENG

Provider Business Mailing Address
First Line	:	2408 VIA VILLANI APT 2235
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76109-5524
Country	:	US
Telephone Number	:	682-248-7390
Fax Number	:

Provider Business Practice Location Address
First Line	:	1217 GRAND AVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76164-9041
Country	:	US
Telephone Number	:	817-625-7733
Fax Number	:

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

Provider Enumeration Date	:	09/03/2015
Last Update Date	:	09/03/2015

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Directions to “ LINDA OCHIENG ” Practice Location

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