Provider Demographics
NPI:1003456542
Name:OGBONNA, CATHERINE (PMHNP)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:
Last Name:OGBONNA
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7602 CRESCENT LAKE CT
Mailing Address - Street 2:
Mailing Address - City:ROSENBERG
Mailing Address - State:TX
Mailing Address - Zip Code:77469-4676
Mailing Address - Country:US
Mailing Address - Phone:832-298-9223
Mailing Address - Fax:
Practice Address - Street 1:2100 PRESTON ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77469-1419
Practice Address - Country:US
Practice Address - Phone:281-344-4720
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-13
Last Update Date:2022-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP144529363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX431380101Medicaid
TX431380103Medicaid