Individual provider Active NPI

Chukwuemeka George Ogwudile

  • Adult Psychiatric/Mental Health Registered Nurse
  • Plano, TX
National Provider Identifier
1114627742
Registry record updated Sep 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Psychiatric/Mental Health Registered NurseTaxonomy code 163WP0809X
License
867361 Issued in TX
Practice address
7205 Petersburg Dr
Plano, TX 75074-2049
Phone
(972) 207-0231
NPI assigned
Mar 2, 2023
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 11, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Psychiatric/Mental Health Registered Nurse 163WP0809X 867361 TX Primary

Addresses

Primary practice location

7205 Petersburg Dr
Plano, TX 75074-2049

Mailing address

7205 Petersburg Dr
Plano, TX 75074-2049
Phone (972) 207-0231

Other identifiers 1

IdentifierTypeStateIssuer
1114627742MedicaidTX

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
867361TXMDAdult Psychiatric/Mental Health Registered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Back to Life Services LLC CurrentSince Oct 8, 2023 Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1677715200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1757548800000",
    "number": "1114627742",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7205 PETERSBURG DR",
            "city": "PLANO",
            "state": "TX",
            "postal_code": "750742049",
            "telephone_number": "972-207-0231"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7205 PETERSBURG DR",
            "city": "PLANO",
            "state": "TX",
            "postal_code": "750742049",
            "telephone_number": "972-207-0231"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OGWUDILE",
        "first_name": "CHUKWUEMEKA",
        "middle_name": "GEORGE",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-03-02",
        "last_updated": "2025-09-11",
        "certification_date": "2023-09-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WP0809X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Psychiatric/Mental Health, Adult",
            "state": "TX",
            "license": "867361",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1114627742",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Plano, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.