Provider Demographics
NPI:1780192666
Name:EZEMA, NKECHI F (PMHNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:NKECHI
Middle Name:F
Last Name:EZEMA
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1075 WOOD STREAM DR
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052-8838
Mailing Address - Country:US
Mailing Address - Phone:469-684-2454
Mailing Address - Fax:972-220-8329
Practice Address - Street 1:2900 W PARK ROW DR STE C
Practice Address - Street 2:
Practice Address - City:PANTEGO
Practice Address - State:TX
Practice Address - Zip Code:76013-2047
Practice Address - Country:US
Practice Address - Phone:214-483-1993
Practice Address - Fax:214-301-3171
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-13
Last Update Date:2021-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP136133363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health