Provider Demographics
NPI:1316686504
Name:OFORDU, CALLISTER UJU
Entity type:Individual
Prefix:
First Name:CALLISTER
Middle Name:UJU
Last Name:OFORDU
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 1:7318 SOMERSET HILL LN
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77407-7825
Mailing Address - Country:US
Mailing Address - Phone:832-670-2283
Mailing Address - Fax:
Practice Address - Street 1:7318 SOMERSET HILL LN
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77407-7825
Practice Address - Country:US
Practice Address - Phone:832-670-2283
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-03
Last Update Date:2022-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1064793363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health