Provider Demographics
NPI:1144417106
Name:UKOR, AUGUSTINE (NP)
Entity Type:Individual
Prefix:
First Name:AUGUSTINE
Middle Name:
Last Name:UKOR
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9711 S MASON RD # 125-267
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77407-7167
Mailing Address - Country:US
Mailing Address - Phone:713-909-6764
Mailing Address - Fax:248-458-4571
Practice Address - Street 1:9711 S MASON RD # 125-267
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77407-7167
Practice Address - Country:US
Practice Address - Phone:713-909-6764
Practice Address - Fax:248-458-4571
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-03
Last Update Date:2021-10-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXAP132012363LA2200X
261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
1720623192OtherNPI FOR CHRISTLINE HEALTHCARE INC