Provider Demographics
NPI:1497357206
Name:OTUCHO, ELIZABETH KERUBO (PMHNP)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:KERUBO
Last Name:OTUCHO
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 1:5409 PINEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75071-8384
Mailing Address - Country:US
Mailing Address - Phone:817-405-0586
Mailing Address - Fax:804-612-5201
Practice Address - Street 1:5409 PINEWOOD DR
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75071-8384
Practice Address - Country:US
Practice Address - Phone:817-405-0586
Practice Address - Fax:804-612-5201
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-16
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1019612363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health