Provider Demographics
NPI:1992334528
Name:ONYENEKE, ANSELM NNADOZIE (PMHNP-BC / CNP)
Entity type:Individual
Prefix:
First Name:ANSELM
Middle Name:NNADOZIE
Last Name:ONYENEKE
Suffix:
Gender:M
Credentials:PMHNP-BC / CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7402 LAKE RIDGE PKWY APT 3218
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75054-0356
Mailing Address - Country:US
Mailing Address - Phone:817-891-5557
Mailing Address - Fax:
Practice Address - Street 1:2909 E ARKANSAS LN STE C
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76010-6930
Practice Address - Country:US
Practice Address - Phone:817-891-5557
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-06
Last Update Date:2024-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX225531163W00000X
NM78676363LP0808X
TX1002230363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse