Provider Demographics
NPI:1992599617
Name:OKONKWO, PRISCA CHINELO (NP)
Entity type:Individual
Prefix:
First Name:PRISCA
Middle Name:CHINELO
Last Name:OKONKWO
Suffix:
Gender:
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1710 KNOLLWOOD RD
Mailing Address - Street 2:
Mailing Address - City:WYLIE
Mailing Address - State:TX
Mailing Address - Zip Code:75098-0347
Mailing Address - Country:US
Mailing Address - Phone:313-646-0544
Mailing Address - Fax:
Practice Address - Street 1:1221 W AIRPORT FWY STE 209
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75062-6209
Practice Address - Country:US
Practice Address - Phone:214-777-2703
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-07
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF12230769363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily