Provider Demographics
NPI:1619230760
Name:OKOYE, OBICHUKWU JOSHUA (PA-C)
Entity Type:Individual
Prefix:
First Name:OBICHUKWU
Middle Name:JOSHUA
Last Name:OKOYE
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:PO BOX 26726
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78755-0726
Mailing Address - Country:US
Mailing Address - Phone:512-407-8686
Mailing Address - Fax:512-406-6216
Practice Address - Street 1:1401 MEDICAL PKWY
Practice Address - Street 2:BLDG. B, SUITE 220
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-7763
Practice Address - Country:US
Practice Address - Phone:512-324-4083
Practice Address - Fax:512-324-4717
Is Sole Proprietor?:No
Enumeration Date:2012-06-22
Last Update Date:2013-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363AM0700X
TXPA07973363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX307476702Medicaid
TX307476704Medicaid
TX307476701Medicaid
TX307476703Medicaid
TX307476704Medicaid
TXTXB162729Medicare PIN
TXTXB162731Medicare PIN
TXTXB162730Medicare PIN
TXP01193227Medicare PIN