Provider Demographics
NPI:1386230795
Name:OLUOCH, MILLICENT AKINYI
Entity Type:Individual
Prefix:
First Name:MILLICENT
Middle Name:AKINYI
Last Name:OLUOCH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2008 WINDCASTLE DR
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-5014
Mailing Address - Country:US
Mailing Address - Phone:214-406-0147
Mailing Address - Fax:
Practice Address - Street 1:2008 WINDCASTLE DR
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-5014
Practice Address - Country:US
Practice Address - Phone:214-406-0147
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-19
Last Update Date:2020-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1018114363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty