Provider Demographics
NPI:1982989083
Name:OMOROGBE, MARIE MONYATO (NP)
Entity Type:Individual
Prefix:MRS
First Name:MARIE
Middle Name:MONYATO
Last Name:OMOROGBE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:MARIE
Other - Middle Name:MONYATO
Other - Last Name:KARMON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PMHNP
Mailing Address - Street 1:7908 MODESTO DR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76001-6102
Mailing Address - Country:US
Mailing Address - Phone:817-703-9562
Mailing Address - Fax:817-453-0571
Practice Address - Street 1:7908 MODESTO DR
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76001-6102
Practice Address - Country:US
Practice Address - Phone:817-703-9562
Practice Address - Fax:817-453-0571
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-20
Last Update Date:2020-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP145310363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health