Basic Information
| Provider Information | |||||||||
| NPI: | 1194359117 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AGUM OMA | ||||||||
| FirstName: | NYAMSICK | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3707 BASALT ST | ||||||||
| Address2: | |||||||||
| City: | IOWA COLONY | ||||||||
| State: | TX | ||||||||
| PostalCode: | 775831578 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3104627068 | ||||||||
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| Practice Location | |||||||||
| Address1: | 10851 SCARSDALE BLVD STE 160 | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770895737 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2818241480 | ||||||||
| FaxNumber: | 2812206407 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/28/2020 | ||||||||
| LastUpdateDate: | 01/25/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/25/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0808X | AP144640 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
No ID Information.