Provider Demographics
NPI:1659941169
Name:NNABUENYI CHUKWUDEBE, CHINYELU (NP)
Entity type:Individual
Prefix:DR
First Name:CHINYELU
Middle Name:
Last Name:NNABUENYI CHUKWUDEBE
Suffix:
Gender:
Credentials:NP
Other - Prefix:
Other - First Name:CHINYELU
Other - Middle Name:JUDITH PHILIPPA
Other - Last Name:NNABUENYI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7400 LAKE FRONT TRL
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76002-4753
Mailing Address - Country:US
Mailing Address - Phone:701-721-5015
Mailing Address - Fax:
Practice Address - Street 1:7400 LAKE FRONT TRL
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76002-4753
Practice Address - Country:US
Practice Address - Phone:701-721-5015
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-28
Last Update Date:2025-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1154659363LP0808X
TX895783163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse