Provider Demographics
NPI:1558449603
Name:NWOSU, VICTORIA K (MD)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:K
Last Name:NWOSU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1307 8TH AVE STE 608
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-4140
Mailing Address - Country:US
Mailing Address - Phone:817-921-4191
Mailing Address - Fax:817-926-6045
Practice Address - Street 1:1307 8TH AVE STE 608
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-4109
Practice Address - Country:US
Practice Address - Phone:817-921-4191
Practice Address - Fax:817-926-6045
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2009-009172084N0400X
SCLL280842084N0400X
TXP42162084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX547906ZXU5OtherMEDICARE
TX3095101Medicaid