Provider Demographics
NPI:1922547090
Name:ADODO, OKWUCHI VIVIAN (FNP)
Entity type:Individual
Prefix:MRS
First Name:OKWUCHI
Middle Name:VIVIAN
Last Name:ADODO
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:OKWUCHI
Other - Middle Name:VIVIAN
Other - Last Name:ADODO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:26502 CRIMSON BLUFF LN
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-7655
Mailing Address - Country:US
Mailing Address - Phone:718-844-3203
Mailing Address - Fax:
Practice Address - Street 1:26502 CRIMSON BLUFF LN
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-7655
Practice Address - Country:US
Practice Address - Phone:718-844-3203
Practice Address - Fax:281-667-4880
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-21
Last Update Date:2020-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QU0200X
TXAP133355363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4102352Medicaid