Provider Demographics
NPI:1851406573
Name:OKOTIE-EBOH, ANGELA I (NP)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:I
Last Name:OKOTIE-EBOH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16520 STEINHAGEN RD
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77429-7173
Mailing Address - Country:US
Mailing Address - Phone:281-687-3413
Mailing Address - Fax:
Practice Address - Street 1:21922 BELLAIRE BLVD STE 600
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77407-3919
Practice Address - Country:US
Practice Address - Phone:832-831-3651
Practice Address - Fax:832-831-3652
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX643307363L00000X
TX2011021217363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX176076101Medicaid
TX611937Medicare ID - Type Unspecified
TX176076101Medicaid