Provider Demographics
NPI:1316618929
Name:OKAFOR, CHIZOBA GERALD
Entity type:Individual
Prefix:
First Name:CHIZOBA
Middle Name:GERALD
Last Name:OKAFOR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1106 N HWY 360 STE 220
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75050-2511
Mailing Address - Country:US
Mailing Address - Phone:817-983-8017
Mailing Address - Fax:
Practice Address - Street 1:1106 N HWY 360 STE 220
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75050-2511
Practice Address - Country:US
Practice Address - Phone:817-983-8017
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-23
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1035831363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health