Provider Demographics
NPI:1073029567
Name:OKEKE, JUSTINA ADA (FNP)
Entity Type:Individual
Prefix:MRS
First Name:JUSTINA
Middle Name:ADA
Last Name:OKEKE
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 1:318 LAKE WICHITA DR
Mailing Address - Street 2:
Mailing Address - City:WYLIE
Mailing Address - State:TX
Mailing Address - Zip Code:75098-4890
Mailing Address - Country:US
Mailing Address - Phone:972-429-5280
Mailing Address - Fax:
Practice Address - Street 1:318 LAKE WICHITA DR
Practice Address - Street 2:
Practice Address - City:WYLIE
Practice Address - State:TX
Practice Address - Zip Code:75098-4890
Practice Address - Country:US
Practice Address - Phone:972-429-5280
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-19
Last Update Date:2018-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF12170454363LF0000X
TX765427163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse