1689308140 NPI number — MRS. ALYESSA JAYTON EGON OKELLO MSN, APRN, FNP-C

Table of content: MRS. ALYESSA JAYTON EGON OKELLO MSN, APRN, FNP-C (NPI 1689308140)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689308140 NPI number — MRS. ALYESSA JAYTON EGON OKELLO MSN, APRN, FNP-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OKELLO
Provider First Name:
ALYESSA
Provider Middle Name:
JAYTON EGON
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MSN, APRN, FNP-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
EGON
Provider Other First Name:
ALYESSA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
NP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1689308140
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/14/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3104 125TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LUBBOCK
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79423-7904
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
806-300-3180
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2602 AVENUE Q
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LUBBOCK
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79411-2444
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-747-1780
Provider Business Practice Location Address Fax Number:
806-744-4432
Provider Enumeration Date:
07/11/2022

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: 1100423 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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