Provider Demographics
NPI:1013507276
Name:ANYANWU, KENNEDY OGBONNA (NP)
Entity Type:Individual
Prefix:
First Name:KENNEDY
Middle Name:OGBONNA
Last Name:ANYANWU
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11352 SUGAR PARK LN
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478-1406
Mailing Address - Country:US
Mailing Address - Phone:832-248-4636
Mailing Address - Fax:
Practice Address - Street 1:11352 SUGAR PARK LN
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-1406
Practice Address - Country:US
Practice Address - Phone:832-248-4636
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-21
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1020418363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health