Provider Demographics
NPI:1679243562
Name:OKEMWA, REUBEN NYAACHI (APRN)
Entity Type:Individual
Prefix:MR
First Name:REUBEN
Middle Name:NYAACHI
Last Name:OKEMWA
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:721 PEBBLE BEACH DR
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75043-5621
Mailing Address - Country:US
Mailing Address - Phone:469-693-6744
Mailing Address - Fax:
Practice Address - Street 1:721 PEBBLE BEACH DR
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75043-5621
Practice Address - Country:US
Practice Address - Phone:469-693-6744
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-14
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1049435363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty