MEDICARE: PRISCA CHINELO OKONKWO NP

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	F12230769	TX

General Provider Information

NPI Number	:	1992599617
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PRISCA CHINELO OKONKWO NP

Provider Business Mailing Address
First Line	:	1710 KNOLLWOOD RD
Second Line	:
City	:	WYLIE
State	:	TX
Zip	:	75098-0347
Country	:	US
Telephone Number	:	313-646-0544
Fax Number	:

Provider Business Practice Location Address
First Line	:	1221 W AIRPORT FWY STE 209
Second Line	:
City	:	IRVING
State	:	TX
Zip	:	75062-6209
Country	:	US
Telephone Number	:	214-777-2703
Fax Number	:

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

Provider Enumeration Date	:	04/07/2025
Last Update Date	:	04/07/2025

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