Organization
PEDICARE CHILDRENS CLINIC PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KINGSLEY OKONKWO MD (PRESIDENT)
(361) 334-0613
Entity
Organization
Contact information
Practice address
2101 N MIDLAND DR STE 14A, MIDLAND, TX 79707-5507
(432) 695-6300
(326) 956-5714
Mailing address
2101 N MIDLAND DR STE 14A, MIDLAND, TX 79707-5507
(432) 695-6300
(432) 695-6571
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
P4362
TX
208000000X
Pediatrics Physician
Q5518
TX
363LF0000X
Family Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
AP144543
ALL
TX
01
—
P4362
STATE LICENSE
TX
01
—
Q5518
STATE LICENSE
TX
Enumeration date
03/23/2017
Last updated
02/10/2022
Update your record
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