Provider Demographics
NPI:1124597117
Name:IWU, KELECHI EVANGELINE (NP)
Entity Type:Individual
Prefix:
First Name:KELECHI
Middle Name:EVANGELINE
Last Name:IWU
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18515 TWILIGHT ARBOR TRL
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77407-5232
Mailing Address - Country:US
Mailing Address - Phone:405-410-7348
Mailing Address - Fax:
Practice Address - Street 1:2111 OLD HOLZWARTH RD APT 2301
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77388-4693
Practice Address - Country:US
Practice Address - Phone:405-410-7348
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-19
Last Update Date:2020-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP140095363LF0000X
TX776675163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily