Provider Demographics
NPI:1417661638
Name:IMOUOKHOME, JULIET ALILETU
Entity Type:Individual
Prefix:MRS
First Name:JULIET
Middle Name:ALILETU
Last Name:IMOUOKHOME
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 1:455 PARK GROVE DR
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77450-1572
Mailing Address - Country:US
Mailing Address - Phone:281-492-8888
Mailing Address - Fax:
Practice Address - Street 1:455 PARK GROVE DR
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450-1572
Practice Address - Country:US
Practice Address - Phone:281-492-8888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-11
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10998129363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health