Provider Demographics
NPI:1275935512
Name:OFFOR, ONYINYE OBIAGELI (NP-C)
Entity Type:Individual
Prefix:MRS
First Name:ONYINYE
Middle Name:OBIAGELI
Last Name:OFFOR
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:ONYINYECHUKWU
Other - Middle Name:OBY
Other - Last Name:OFFOR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:651 DUNLOP LN
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37040-5015
Mailing Address - Country:US
Mailing Address - Phone:931-502-1000
Mailing Address - Fax:
Practice Address - Street 1:651 DUNLOP LN
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37040-5015
Practice Address - Country:US
Practice Address - Phone:931-502-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-18
Last Update Date:2019-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000019140363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100457290Medicaid