Provider Demographics
NPI:1265957757
Name:ILOMA, UCHENNA (FNP)
Entity type:Individual
Prefix:
First Name:UCHENNA
Middle Name:
Last Name:ILOMA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 S MAIN ST STE 240
Mailing Address - Street 2:
Mailing Address - City:KELLER
Mailing Address - State:TX
Mailing Address - Zip Code:76248-5009
Mailing Address - Country:US
Mailing Address - Phone:817-912-8150
Mailing Address - Fax:
Practice Address - Street 1:620 S MAIN ST STE 240
Practice Address - Street 2:
Practice Address - City:KELLER
Practice Address - State:TX
Practice Address - Zip Code:76248-5009
Practice Address - Country:US
Practice Address - Phone:817-912-8150
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-07
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP134632363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily