Provider Demographics
NPI:1992379762
Name:UZOMAH, OGECHI (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:OGECHI
Middle Name:
Last Name:UZOMAH
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 S PARK ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94107-1809
Mailing Address - Country:US
Mailing Address - Phone:855-249-3663
Mailing Address - Fax:855-249-6362
Practice Address - Street 1:2025 LAKE MOSS LN
Practice Address - Street 2:
Practice Address - City:LITTLE ELM
Practice Address - State:TX
Practice Address - Zip Code:75068-1297
Practice Address - Country:US
Practice Address - Phone:469-531-4672
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-17
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1038325363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health