Provider Demographics
NPI:1831818970
Name:OKONKWO, UGOCHUKWU T (PA-C)
Entity type:Individual
Prefix:
First Name:UGOCHUKWU
Middle Name:T
Last Name:OKONKWO
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:UGO
Other - Middle Name:
Other - Last Name:OKONKWO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:27595 INTERSTATE 10 W APT 332
Mailing Address - Street 2:
Mailing Address - City:BOERNE
Mailing Address - State:TX
Mailing Address - Zip Code:78006-6638
Mailing Address - Country:US
Mailing Address - Phone:480-434-9393
Mailing Address - Fax:
Practice Address - Street 1:551 HILL COUNTRY DR
Practice Address - Street 2:
Practice Address - City:KERRVILLE
Practice Address - State:TX
Practice Address - Zip Code:78028-6085
Practice Address - Country:US
Practice Address - Phone:480-434-9393
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-23
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA18793363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant