Provider Demographics
NPI:1114416062
Name:MONEKE, PATRICK ANAYO
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:ANAYO
Last Name:MONEKE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7268 PORTILLO
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75054-0073
Mailing Address - Country:US
Mailing Address - Phone:817-366-0950
Mailing Address - Fax:
Practice Address - Street 1:7268 PORTILLO
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75054-0073
Practice Address - Country:US
Practice Address - Phone:817-366-0950
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-07
Last Update Date:2018-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3589731Medicaid