Provider Demographics
NPI:1861006249
Name:AGBOGHAI, OKENYE LAWRENCE
Entity Type:Individual
Prefix:
First Name:OKENYE
Middle Name:LAWRENCE
Last Name:AGBOGHAI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:LAWRENCE
Other - Middle Name:OKENYE
Other - Last Name:AGBOGHAI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:9916 BITTERROOT DR
Mailing Address - Street 2:
Mailing Address - City:OAK POINT
Mailing Address - State:TX
Mailing Address - Zip Code:75068-0639
Mailing Address - Country:US
Mailing Address - Phone:832-887-4710
Mailing Address - Fax:
Practice Address - Street 1:9916 BITTERROOT DR
Practice Address - Street 2:
Practice Address - City:OAK POINT
Practice Address - State:TX
Practice Address - Zip Code:75068-0639
Practice Address - Country:US
Practice Address - Phone:832-887-4710
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-03
Last Update Date:2020-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX832118163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health