Provider Demographics
NPI:1275939761
Name:OMORAGBON, IYEN (FNP)
Entity Type:Individual
Prefix:
First Name:IYEN
Middle Name:
Last Name:OMORAGBON
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 1:120 E FM 544 STE 72
Mailing Address - Street 2:
Mailing Address - City:MURPHY
Mailing Address - State:TX
Mailing Address - Zip Code:75094-4035
Mailing Address - Country:US
Mailing Address - Phone:469-949-6080
Mailing Address - Fax:972-634-1038
Practice Address - Street 1:4157 BEDFORD RD STE 200
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76021-5228
Practice Address - Country:US
Practice Address - Phone:469-949-6080
Practice Address - Fax:972-634-1038
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-10
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP126757363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily