Provider Demographics
NPI:1134769656
Name:IWUORISHA, NKECHINYERE CONCILIA
Entity type:Individual
Prefix:
First Name:NKECHINYERE
Middle Name:CONCILIA
Last Name:IWUORISHA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12720 BRANT ROCK DR APT 2608
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77082-5441
Mailing Address - Country:US
Mailing Address - Phone:832-461-3326
Mailing Address - Fax:
Practice Address - Street 1:929 GESSNER RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024-2515
Practice Address - Country:US
Practice Address - Phone:713-242-3720
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-13
Last Update Date:2022-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP144371363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX419118103Medicaid
TX419118101Medicaid