Provider Demographics
NPI:1720743479
Name:OKONKWO, NIKKY NNEKA
Entity Type:Individual
Prefix:
First Name:NIKKY
Middle Name:NNEKA
Last Name:OKONKWO
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 1:5104 CHINA BERRY DR
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75070-4671
Mailing Address - Country:US
Mailing Address - Phone:972-201-6965
Mailing Address - Fax:
Practice Address - Street 1:5104 CHINA BERRY DR
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75070-4671
Practice Address - Country:US
Practice Address - Phone:972-201-6965
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-07
Last Update Date:2021-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX682363LS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LS0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerSchool