Provider Demographics
NPI:1972539419
Name:UME-NWAGBO, PEARL NGOZIKA (FNP)
Entity Type:Individual
Prefix:
First Name:PEARL
Middle Name:NGOZIKA
Last Name:UME-NWAGBO
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 70403
Mailing Address - Street 2:807 UNIVERSITY PARKWAY
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37614-1703
Mailing Address - Country:US
Mailing Address - Phone:423-439-4078
Mailing Address - Fax:423-439-4060
Practice Address - Street 1:807 UNIVERSITY PARKWAY
Practice Address - Street 2:ROY S NICKS HALL ROOM 160
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37614-7114
Practice Address - Country:US
Practice Address - Phone:423-439-4225
Practice Address - Fax:423-439-4560
Is Sole Proprietor?:No
Enumeration Date:2006-06-25
Last Update Date:2007-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN006719363LF0000X
TNAPN0000006719363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3108812OtherBLUECROSSBLUESHIELD
TNTN01D5OtherJOHN DEERE
TN3495755Medicaid
TNS54614Medicare UPIN
TN3495755Medicaid