Provider Demographics
NPI:1386856946
Name:OKOYE, CLEMENTINA O (RN)
Entity Type:Individual
Prefix:MRS
First Name:CLEMENTINA
Middle Name:O
Last Name:OKOYE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4807 OSAGE CT
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76018-1072
Mailing Address - Country:US
Mailing Address - Phone:817-793-2376
Mailing Address - Fax:817-784-9865
Practice Address - Street 1:4807 OSAGE CT
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76018-1072
Practice Address - Country:US
Practice Address - Phone:817-793-2376
Practice Address - Fax:817-784-9865
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2008-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX009400251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX457982Medicare Oscar/Certification