Provider Demographics
NPI:1013550037
Name:OPPONG, PRUDENCE CORNELIUS (FNP)
Entity Type:Individual
Prefix:
First Name:PRUDENCE
Middle Name:CORNELIUS
Last Name:OPPONG
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15010 MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77079-4302
Mailing Address - Country:US
Mailing Address - Phone:281-238-7870
Mailing Address - Fax:
Practice Address - Street 1:15010 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77079-4302
Practice Address - Country:US
Practice Address - Phone:281-238-7870
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-22
Last Update Date:2023-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF0319036B207Q00000X
TX1013550037363LF0000X
TXAP142558363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine