Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 800894 | TX |
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | AP145774 | TX |
NPI | 1013542158 |
---|---|
Provider Name | Lloyd Ehigie Esene |
First Address | Malvern, PA 19355-0746 |
Second Address | Amarillo, TX 79106-1707 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/03/2020 |
Last Update Date | 10/07/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1B1722 | MEDICARE (01) | TX |
200906690A | (05) | OK |