Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | AP142728 | TX |
NPI | 1013561216 |
---|---|
Provider Name | Osaretin Okoro |
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 | 26/07/2019 |
Last Update Date | 23/01/2020 |