1073030987 NPI number — MS. ROSE NKECHI EMEGHARA FNP-C

Table of content: MS. ROSE NKECHI EMEGHARA FNP-C (NPI 1073030987)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073030987 NPI number — MS. ROSE NKECHI EMEGHARA FNP-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
EMEGHARA
Provider First Name:
ROSE
Provider Middle Name:
NKECHI
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
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:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1073030987
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/23/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5315 CYPRESS CREEK PKWY STE B
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77069-4410
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
346-718-2146
Provider Business Mailing Address Fax Number:
832-717-2781

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
714 S ROBB ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TRINITY
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75862-7586
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
346-718-2146
Provider Business Practice Location Address Fax Number:
832-717-2781
Provider Enumeration Date:
08/23/2017

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: 363LF0000X , with the licence number:  AP191153 , 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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