Provider Demographics
NPI:1043802952
Name:OTIENO, SYLVIA (PMHNP)
Entity Type:Individual
Prefix:
First Name:SYLVIA
Middle Name:
Last Name:OTIENO
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 1:9104 CHALKSTONE ST
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76002-5003
Mailing Address - Country:US
Mailing Address - Phone:469-274-5391
Mailing Address - Fax:
Practice Address - Street 1:9104 CHALKSTONE ST
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76002-5003
Practice Address - Country:US
Practice Address - Phone:469-274-5391
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-11
Last Update Date:2021-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1016068363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health