Provider Demographics
NPI:1891218814
Name:ECKENROED, RAEL OKOTH (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:RAEL
Middle Name:OKOTH
Last Name:ECKENROED
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:MS
Other - First Name:RAEL
Other - Middle Name:ATIENO
Other - Last Name:OKOTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:206 SALEM DR
Mailing Address - Street 2:
Mailing Address - City:EULESS
Mailing Address - State:TX
Mailing Address - Zip Code:76039-3822
Mailing Address - Country:US
Mailing Address - Phone:1817-500-2365
Mailing Address - Fax:817-355-0396
Practice Address - Street 1:808 S BALLARD AVE STE 140B
Practice Address - Street 2:
Practice Address - City:WYLIE
Practice Address - State:TX
Practice Address - Zip Code:75098-4228
Practice Address - Country:US
Practice Address - Phone:972-878-9934
Practice Address - Fax:972-476-0904
Is Sole Proprietor?:No
Enumeration Date:2017-07-21
Last Update Date:2017-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX134903363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily