Provider Demographics
NPI:1235964685
Name:UKPONG, MONIQUE (APRN)
Entity type:Individual
Prefix:
First Name:MONIQUE
Middle Name:
Last Name:UKPONG
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:MONIQUE
Other - Middle Name:
Other - Last Name:POULIOT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3535 BLUFFS LN APT 12208
Mailing Address - Street 2:
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-1238
Mailing Address - Country:US
Mailing Address - Phone:469-600-0802
Mailing Address - Fax:
Practice Address - Street 1:7033 BRYANT IRVIN RD STE 100
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-4276
Practice Address - Country:US
Practice Address - Phone:469-600-0802
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-05
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1152827363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily