Provider Demographics
NPI:1104454602
Name:ANYOGU, OBIOMA (APRN, FNP-BC)
Entity type:Individual
Prefix:
First Name:OBIOMA
Middle Name:
Last Name:ANYOGU
Suffix:
Gender:F
Credentials:APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1110 E PLEASANT RUN RD
Mailing Address - Street 2:
Mailing Address - City:DESOTO
Mailing Address - State:TX
Mailing Address - Zip Code:75115-4202
Mailing Address - Country:US
Mailing Address - Phone:972-230-8881
Mailing Address - Fax:972-230-8810
Practice Address - Street 1:201 FERRIS AVE STE I
Practice Address - Street 2:
Practice Address - City:WAXAHACHIE
Practice Address - State:TX
Practice Address - Zip Code:75165-3660
Practice Address - Country:US
Practice Address - Phone:972-937-1613
Practice Address - Fax:972-937-0891
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-30
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP145029363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty