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NPI Code Detail

MEDICARE: DIEPREYE OMIEBA AKUIYIBO APRN

MEDICARE: DIEPREYE OMIEBA AKUIYIBO APRN
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
1363LA2100XAcute Care Nurse Practitioner1201342TX

General Provider Information

NPI Number : 1942092671
Entity Type Code : Individual
Provider Name (Legal Business Name) : DIEPREYE OMIEBA AKUIYIBO APRN
Provider Business Mailing Address
First Line : PO BOX 2129
Second Line :
City : ODESSA
State : TX
Zip : 79760-2129
Country : US
Telephone Number : 432-640-2403
Fax Number : 432-640-2897
Provider Business Practice Location Address
First Line : 500 W 4TH ST
Second Line :
City : ODESSA
State : TX
Zip : 79761-5001
Country : US
Telephone Number : 432-640-2403
Fax Number : 432-640-2797
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/19/2025
Last Update Date : 05/19/2026

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