Basic Information
| Provider Information | |||||||||
| NPI: | 1912274622 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JON-UBABUCO | ||||||||
| FirstName: | NNEKA | ||||||||
| MiddleName: | CHINELO | ||||||||
| NamePrefix: | MISS | ||||||||
| NameSuffix: | |||||||||
| Credential: | PMHNP-BC | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | UBABUKOH | ||||||||
| OtherFirstName: | NNEKA | ||||||||
| OtherMiddleName: | CHINELO | ||||||||
| OtherNamePrefix: | MISS | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 220 N PARK BLVD | ||||||||
| Address2: | SUITE 114 | ||||||||
| City: | GRAPEVINE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 760516987 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8174887771 | ||||||||
| FaxNumber: | 8174887774 | ||||||||
| Practice Location | |||||||||
| Address1: | 220 N PARK BLVD | ||||||||
| Address2: | SUITE 114 | ||||||||
| City: | GRAPEVINE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 760516987 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8174887771 | ||||||||
| FaxNumber: | 8174887774 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/23/2011 | ||||||||
| LastUpdateDate: | 11/30/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0808X | AP121280 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
No ID Information.