Provider Demographics
NPI:1841701265
Name:KIROCHI, JOSEPHAT OMWENO (RN)
Entity type:Individual
Prefix:MR
First Name:JOSEPHAT
Middle Name:OMWENO
Last Name:KIROCHI
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5784 JILLIAN WAY
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052-0418
Mailing Address - Country:US
Mailing Address - Phone:817-449-7705
Mailing Address - Fax:
Practice Address - Street 1:5784 JILLIAN WAY
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75052-0418
Practice Address - Country:US
Practice Address - Phone:817-449-7705
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-12
Last Update Date:2017-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX846625163WH0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WH0500XNursing Service ProvidersRegistered NurseHemodialysisGroup - Single Specialty