Provider Demographics
NPI:1114428513
Name:DAVIS-OSUAGWU, CALLISTA NKEIRUKA (FNP,MSN)
Entity type:Individual
Prefix:
First Name:CALLISTA
Middle Name:NKEIRUKA
Last Name:DAVIS-OSUAGWU
Suffix:
Gender:F
Credentials:FNP,MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14514 SMITH BRIDGE LN
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77498-2190
Mailing Address - Country:US
Mailing Address - Phone:835-250-6881
Mailing Address - Fax:
Practice Address - Street 1:14514 SMITH BRIDGE LN
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77498-2190
Practice Address - Country:US
Practice Address - Phone:835-250-6881
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-22
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1058521363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily