Provider Demographics
NPI:1689289308
Name:EKPENYONG, JULIANA
Entity Type:Individual
Prefix:MRS
First Name:JULIANA
Middle Name:
Last Name:EKPENYONG
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:JULIANA
Other - Middle Name:EHIMHEN
Other - Last Name:OKOGUN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP STUDENT
Mailing Address - Street 1:3002 FAIRWAY OAKS LN
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75605-2651
Mailing Address - Country:US
Mailing Address - Phone:917-280-9521
Mailing Address - Fax:
Practice Address - Street 1:3002 FAIRWAY OAKS LN
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75605-2651
Practice Address - Country:US
Practice Address - Phone:917-280-9521
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-10
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TX1029215363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program