Provider Demographics
NPI:1033005806
Name:NYABOGA, ELISHA OMARI
Entity type:Individual
Prefix:
First Name:ELISHA
Middle Name:OMARI
Last Name:NYABOGA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21407 PESCADO DR
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77433-3259
Mailing Address - Country:US
Mailing Address - Phone:346-498-5244
Mailing Address - Fax:
Practice Address - Street 1:16401 1ST ST
Practice Address - Street 2:
Practice Address - City:SPLENDORA
Practice Address - State:TX
Practice Address - Zip Code:77372-4026
Practice Address - Country:US
Practice Address - Phone:281-968-4096
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-17
Last Update Date:2025-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1098723363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily