Provider Demographics
NPI:1932993078
Name:JOHN-AGBASI, NKOLICHUKWU VIVIAN (RN)
Entity type:Individual
Prefix:
First Name:NKOLICHUKWU
Middle Name:VIVIAN
Last Name:JOHN-AGBASI
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:NKOLICHUKWU
Other - Middle Name:VIVIAN
Other - Last Name:OKEKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1045 DOG IRON ST
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78633-2901
Mailing Address - Country:US
Mailing Address - Phone:918-457-7384
Mailing Address - Fax:
Practice Address - Street 1:7255 W 98TH TER STE 150
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66212-2215
Practice Address - Country:US
Practice Address - Phone:913-383-9733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-05
Last Update Date:2025-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1168971163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse