Provider Demographics
NPI:1922566710
Name:CHUKWUEMEKA OGBAH, CHIMTUA J (ACNPC-AG)
Entity Type:Individual
Prefix:MR
First Name:CHIMTUA
Middle Name:J
Last Name:CHUKWUEMEKA OGBAH
Suffix:
Gender:M
Credentials:ACNPC-AG
Other - Prefix:MR
Other - First Name:CHIMTUA
Other - Middle Name:J
Other - Last Name:OGBAH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:6565 FANNIN ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2703
Mailing Address - Country:US
Mailing Address - Phone:713-394-6000
Mailing Address - Fax:
Practice Address - Street 1:6565 FANNIN ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2703
Practice Address - Country:US
Practice Address - Phone:713-394-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-11
Last Update Date:2019-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX812769163W00000X
TXAP141001363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163W00000XNursing Service ProvidersRegistered Nurse