Basic Information
| Provider Information | |||||||||
| NPI: | 1619230760 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | OKOYE | ||||||||
| FirstName: | OBICHUKWU | ||||||||
| MiddleName: | JOSHUA | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 26726 | ||||||||
| Address2: | |||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787550726 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5124078686 | ||||||||
| FaxNumber: | 5124066216 | ||||||||
| Practice Location | |||||||||
| Address1: | 1401 MEDICAL PKWY | ||||||||
| Address2: | BLDG. B, SUITE 220 | ||||||||
| City: | CEDAR PARK | ||||||||
| State: | TX | ||||||||
| PostalCode: | 786137763 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5123244083 | ||||||||
| FaxNumber: | 5123244717 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/22/2012 | ||||||||
| LastUpdateDate: | 08/27/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical | 363A00000X | PA07973 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | 307476702 | 05 | TX | MEDICAID | 307476704 | 05 | TX | MEDICAID | 307476701 | 05 | TX | MEDICAID | 307476703 | 05 | TX | MEDICAID |