Basic Information
| Provider Information | |||||||||
| NPI: | 1386978781 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | UKADIKE | ||||||||
| FirstName: | EVELYN | ||||||||
| MiddleName: | EBERE | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | NURSE PRACTITIONER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1105 E 32ND ST | ||||||||
| Address2: | |||||||||
| City: | JOPLIN | ||||||||
| State: | MO | ||||||||
| PostalCode: | 648042879 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4173477600 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 12801 KEYSTONE DR | ||||||||
| Address2: | |||||||||
| City: | BALCH SPRINGS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 75180 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4698786318 | ||||||||
| FaxNumber: | 2147726226 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/01/2009 | ||||||||
| LastUpdateDate: | 09/06/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/06/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 172V00000X | N | Other Service Providers | Community Health Worker | 374U00000X | N | Nursing Service Related Providers | Home Health Aide | 376J00000X | N | Nursing Service Related Providers | Homemaker | 376K00000X | 801108670 | TX | N | Nursing Service Related Providers | Nurse's Aide | 376K00000X | N | Nursing Service Related Providers | Nurse's Aide | 363LP0808X | 2022014834 | MO | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
No ID Information.