Provider Demographics
NPI:1154813491
Name:KALU, NGOZI JENNIFER (FNP-C)
Entity Type:Individual
Prefix:
First Name:NGOZI
Middle Name:JENNIFER
Last Name:KALU
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1132 WEDGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-2807
Mailing Address - Country:US
Mailing Address - Phone:817-592-3309
Mailing Address - Fax:
Practice Address - Street 1:3008 50TH ST STE H
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79413-4130
Practice Address - Country:US
Practice Address - Phone:844-679-7050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-02
Last Update Date:2018-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP136387363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXAP136387OtherTEXAS APRN LICENSE NUMBER