Provider Demographics
NPI:1063121176
Name:NGOZI-IBEH, KOSISOCHI GINIGEME
Entity type:Individual
Prefix:
First Name:KOSISOCHI
Middle Name:GINIGEME
Last Name:NGOZI-IBEH
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 1:425 PINSON RD STE M
Mailing Address - Street 2:
Mailing Address - City:FORNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75126-9774
Mailing Address - Country:US
Mailing Address - Phone:469-977-1300
Mailing Address - Fax:
Practice Address - Street 1:425 PINSON RD STE M
Practice Address - Street 2:
Practice Address - City:FORNEY
Practice Address - State:TX
Practice Address - Zip Code:75126-9774
Practice Address - Country:US
Practice Address - Phone:469-977-1300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-17
Last Update Date:2024-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1097195363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty