Provider Demographics
NPI:1083266274
Name:OKONOFUA, CAROLYN
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:
Last Name:OKONOFUA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3727 DILIDO RD STE 140
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75228-5531
Mailing Address - Country:US
Mailing Address - Phone:214-275-8898
Mailing Address - Fax:214-275-9986
Practice Address - Street 1:3727 DILIDO RD STE 140
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75228-5531
Practice Address - Country:US
Practice Address - Phone:214-275-8898
Practice Address - Fax:214-275-9986
Is Sole Proprietor?:No
Enumeration Date:2019-07-09
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP140241363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily