Provider Demographics
NPI:1275044851
Name:OKOLOCHA, IKECHUKWU HENRY (FNP)
Entity Type:Individual
Prefix:MR
First Name:IKECHUKWU
Middle Name:HENRY
Last Name:OKOLOCHA
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:783 N DENTON TAP RD STE 150
Mailing Address - Street 2:
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-2129
Mailing Address - Country:US
Mailing Address - Phone:469-289-2660
Mailing Address - Fax:
Practice Address - Street 1:783 N DENTON TAP RD STE 150
Practice Address - Street 2:
Practice Address - City:COPPELL
Practice Address - State:TX
Practice Address - Zip Code:75019-2129
Practice Address - Country:US
Practice Address - Phone:469-289-2660
Practice Address - Fax:469-324-4230
Is Sole Proprietor?:No
Enumeration Date:2017-10-23
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP135695363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner