Provider Demographics
NPI:1891469078
Name:AGOKI, MORNA MOKOMBORI
Entity Type:Individual
Prefix:
First Name:MORNA
Middle Name:MOKOMBORI
Last Name:AGOKI
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 1:2620 SHADY GROVE LN
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75071-2715
Mailing Address - Country:US
Mailing Address - Phone:469-471-4702
Mailing Address - Fax:
Practice Address - Street 1:2701 SHORELINE DR STE 151
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76210-0176
Practice Address - Country:US
Practice Address - Phone:940-222-2399
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-02
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1048893363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health