Provider Demographics
NPI:1902441876
Name:OTIENO, EMMA (NP)
Entity type:Individual
Prefix:MS
First Name:EMMA
Middle Name:
Last Name:OTIENO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5508 GYPSUM DR
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75070-1359
Mailing Address - Country:US
Mailing Address - Phone:954-600-9036
Mailing Address - Fax:
Practice Address - Street 1:5508 GYPSUM DR
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75070-1359
Practice Address - Country:US
Practice Address - Phone:954-600-9036
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-14
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP143714363LP0808X
KS79535363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health