Provider Demographics
NPI:1699054668
Name:OKOLO, LAURA O (FNP)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:O
Last Name:OKOLO
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6445 MAIN STREET, OPC24
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030
Mailing Address - Country:US
Mailing Address - Phone:713-441-9948
Mailing Address - Fax:
Practice Address - Street 1:2424 HAMILTON ST
Practice Address - Street 2:SUITE 410
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77004-1200
Practice Address - Country:US
Practice Address - Phone:713-659-3565
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-09
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX801467363LF0000X
TXAP120713363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX283937505Medicaid