Provider Demographics
NPI:1972195840
Name:OKOLI, NKEM (PMHNP)
Entity Type:Individual
Prefix:
First Name:NKEM
Middle Name:
Last Name:OKOLI
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20119 GOSS HOLLOW LN
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77449-0039
Mailing Address - Country:US
Mailing Address - Phone:240-351-7546
Mailing Address - Fax:
Practice Address - Street 1:1015 W CENTERVILLE RD STE 118
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75041-5929
Practice Address - Country:US
Practice Address - Phone:972-807-6016
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-11
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR202112094NP363LP0808X
TX1019599363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health