Provider Demographics
NPI:1417107038
Name:CHUKWUELUE, NWABUEZE NELSON (PA-C)
Entity Type:Individual
Prefix:
First Name:NWABUEZE
Middle Name:NELSON
Last Name:CHUKWUELUE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 E. MANSFIELD LANE
Mailing Address - Street 2:1103
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-3665
Mailing Address - Country:US
Mailing Address - Phone:817-668-5698
Mailing Address - Fax:817-473-2298
Practice Address - Street 1:1650 W ROSEDALE ST STE 302
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-7400
Practice Address - Country:US
Practice Address - Phone:817-885-7888
Practice Address - Fax:817-885-7811
Is Sole Proprietor?:No
Enumeration Date:2008-09-19
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA05934363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX201335102Medicaid
TX201335101Medicaid
TX201335103Medicaid
TX201335103Medicaid
TX8L14726Medicare PIN
TX8L10925Medicare PIN