Provider Demographics
NPI:1003686858
Name:OKIENYA, PEACE ISHMAEL BOSIRE (DNP, APRN, PMHNP-BC)
Entity type:Individual
Prefix:DR
First Name:PEACE
Middle Name:ISHMAEL BOSIRE
Last Name:OKIENYA
Suffix:
Gender:M
Credentials:DNP, APRN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:621 AVENUE G
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75203-3901
Mailing Address - Country:US
Mailing Address - Phone:214-866-9270
Mailing Address - Fax:
Practice Address - Street 1:2911 TURTLE CREEK BLVD STE 300
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75219-6243
Practice Address - Country:US
Practice Address - Phone:214-518-2035
Practice Address - Fax:972-803-3431
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-03
Last Update Date:2025-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1141765363LP0808X, 2084B0040X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
No2084B0040XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyBehavioral Neurology & NeuropsychiatryGroup - Single Specialty