Provider Demographics
NPI:1982732178
Name:OKONKWO, KINGSLEY C (MD)
Entity Type:Individual
Prefix:
First Name:KINGSLEY
Middle Name:C
Last Name:OKONKWO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:912 E 5TH ST
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79761-4605
Mailing Address - Country:US
Mailing Address - Phone:432-334-8845
Mailing Address - Fax:432-334-8875
Practice Address - Street 1:912 E 5TH ST
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79761-4605
Practice Address - Country:US
Practice Address - Phone:432-334-8845
Practice Address - Fax:432-334-8875
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010936062080P0202X
TXP4362208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology