Provider Demographics
NPI:1730567249
Name:EJIAKONYE, CHARITY IFUNANYA (NP)
Entity type:Individual
Prefix:
First Name:CHARITY
Middle Name:IFUNANYA
Last Name:EJIAKONYE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4323 S HAMPTON RD APT 4225
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75232-1058
Mailing Address - Country:US
Mailing Address - Phone:214-331-6534
Mailing Address - Fax:214-433-3046
Practice Address - Street 1:4323 S HAMPTON RD APT 4225
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75232-1058
Practice Address - Country:US
Practice Address - Phone:214-331-6534
Practice Address - Fax:214-433-3046
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-16
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP128148363LP2300X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care