Provider Demographics
NPI:1144790593
Name:OKONKWO, CHIBUGO (PA)
Entity Type:Individual
Prefix:
First Name:CHIBUGO
Middle Name:
Last Name:OKONKWO
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2636 CANTURA DR
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75181-4661
Mailing Address - Country:US
Mailing Address - Phone:469-733-8280
Mailing Address - Fax:
Practice Address - Street 1:2636 CANTURA DR
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75181-4661
Practice Address - Country:US
Practice Address - Phone:469-733-8280
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-28
Last Update Date:2018-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA12476363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant