Provider Demographics
NPI:1851892426
Name:EKEJIUBA, KELECHI NDIDI
Entity Type:Individual
Prefix:
First Name:KELECHI
Middle Name:NDIDI
Last Name:EKEJIUBA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6720 BERTNER AVE
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2604
Mailing Address - Country:US
Mailing Address - Phone:832-355-2666
Mailing Address - Fax:
Practice Address - Street 1:17130 KILDONAN CT
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77407-1730
Practice Address - Country:US
Practice Address - Phone:267-241-8027
Practice Address - Fax:832-608-6001
Is Sole Proprietor?:No
Enumeration Date:2018-02-28
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX847358163W00000X
TXAP144693367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse