Provider Demographics
NPI:1407624141
Name:OGDEN, GENISA ESTELLE (PMHNP)
Entity Type:Individual
Prefix:
First Name:GENISA
Middle Name:ESTELLE
Last Name:OGDEN
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:MRS
Other - First Name:GENISA
Other - Middle Name:ESTELLE
Other - Last Name:OGDEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PMHNP
Mailing Address - Street 1:14185 FM 1008
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:TX
Mailing Address - Zip Code:77535-8276
Mailing Address - Country:US
Mailing Address - Phone:702-762-8534
Mailing Address - Fax:
Practice Address - Street 1:14185 FM 1008
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:TX
Practice Address - Zip Code:77535-8276
Practice Address - Country:US
Practice Address - Phone:702-762-8534
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-12
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1142468363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty