Provider Demographics
NPI:1396456174
Name:OMODUGBA-UDEH, CHRISTIANA UPE (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:CHRISTIANA
Middle Name:UPE
Last Name:OMODUGBA-UDEH
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13355 NOEL RD STE 1100
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75240-6694
Mailing Address - Country:US
Mailing Address - Phone:833-400-0120
Mailing Address - Fax:
Practice Address - Street 1:13355 NOEL RD STE 1100
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75240-6694
Practice Address - Country:US
Practice Address - Phone:833-400-0120
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-12
Last Update Date:2025-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2022026825363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health