Provider Demographics
NPI:1184148645
Name:DIKE, CHINAKA MARY
Entity type:Individual
Prefix:
First Name:CHINAKA
Middle Name:MARY
Last Name:DIKE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4700 LITTLE RD
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76017-1058
Mailing Address - Country:US
Mailing Address - Phone:469-482-9648
Mailing Address - Fax:888-635-4503
Practice Address - Street 1:4700 LITTLE RD
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76017-1058
Practice Address - Country:US
Practice Address - Phone:469-482-9648
Practice Address - Fax:888-635-4503
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-26
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP134069363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily