Basic Information
Provider Information | |||||||||
NPI: | 1649770165 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | SMITH | ||||||||
FirstName: | BLESSING | ||||||||
MiddleName: | UCHECHUKWU | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | PMHNP-BC | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | ETUOKWU | ||||||||
OtherFirstName: | BLESSING | ||||||||
OtherMiddleName: | UCHECHUKWU | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | AGNP-C | ||||||||
OtherLastNameType: | 5 | ||||||||
Mailing Information | |||||||||
Address1: | 9711 S MASON RD STE 125-215 | ||||||||
Address2: |   | ||||||||
City: | RICHMOND | ||||||||
State: | TX | ||||||||
PostalCode: | 774077167 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3469332463 | ||||||||
FaxNumber: | 7132347382 | ||||||||
Practice Location | |||||||||
Address1: | 9711 S MASON RD STE 125-215 | ||||||||
Address2: |   | ||||||||
City: | RICHMOND | ||||||||
State: | TX | ||||||||
PostalCode: | 774077167 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3469332463 | ||||||||
FaxNumber: | 7132347382 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 02/21/2018 | ||||||||
LastUpdateDate: | 06/15/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 06/15/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | AP139645 | TX | Y |   | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |   | 163W00000X | 880842 | TX | N |   | Nursing Service Providers | Registered Nurse |   |
No ID Information.