Provider Demographics
NPI:1184148645
Name:DIKE, CHINAKA MARY
Entity type:Individual
Prefix:
First Name:CHINAKA
Middle Name:MARY
Last Name:DIKE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7664 MCCART AVE
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76133-7803
Mailing Address - Country:US
Mailing Address - Phone:800-218-8989
Mailing Address - Fax:888-638-4240
Practice Address - Street 1:7664 MCCART AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76133-7803
Practice Address - Country:US
Practice Address - Phone:800-218-8989
Practice Address - Fax:888-638-4240
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-26
Last Update Date:2025-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP134069363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily