Provider Demographics
NPI:1871132225
Name:NWACHUKWU, CAROLINE ONYEKACHI (PMHNP)
Entity type:Individual
Prefix:
First Name:CAROLINE
Middle Name:ONYEKACHI
Last Name:NWACHUKWU
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 LONGHORN TRL
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052-3589
Mailing Address - Country:US
Mailing Address - Phone:632-333-8040
Mailing Address - Fax:
Practice Address - Street 1:203 LONGHORN TRL
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75052-3589
Practice Address - Country:US
Practice Address - Phone:632-333-8040
Practice Address - Fax:972-854-6632
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-02
Last Update Date:2020-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP144111363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health