Provider Demographics
NPI:1083323653
Name:OMOKE, JUDITH (MSN, APRN, AGACNP-BC)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:
Last Name:OMOKE
Suffix:
Gender:F
Credentials:MSN, APRN, AGACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1200
Mailing Address - Street 2:
Mailing Address - City:COLLEYVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76034-1200
Mailing Address - Country:US
Mailing Address - Phone:972-203-3600
Mailing Address - Fax:
Practice Address - Street 1:733 FIELD XING
Practice Address - Street 2:
Practice Address - City:AUBREY
Practice Address - State:TX
Practice Address - Zip Code:76227-1499
Practice Address - Country:US
Practice Address - Phone:972-203-3600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-22
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX109473363LA2100X
TX1094743208100000X, 208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty