Provider Demographics
NPI:1235762030
Name:ACHOLONU, KIMBERLY EZINWA (ARNP)
Entity type:Individual
Prefix:MISS
First Name:KIMBERLY
Middle Name:EZINWA
Last Name:ACHOLONU
Suffix:
Gender:
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9801 WESTHEIMER RD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77042-3950
Mailing Address - Country:US
Mailing Address - Phone:832-402-9142
Mailing Address - Fax:832-835-5580
Practice Address - Street 1:1225 NORTH LOOP W
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77008-4722
Practice Address - Country:US
Practice Address - Phone:832-402-9142
Practice Address - Fax:832-835-5580
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-20
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP61040746363LF0000X, 363LP0808X
TX1042917363LP0808X
ID4861876363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health