Emmanuel Etuokwu, AGNP-C, PMHNP-BC

Primary specialty

Adult Health Nurse PractitionerTaxonomy code 363LA2200X

License

AP139648 Issued in TX

Practice address

1300 W Terrell Ave Ste K230
Fort Worth, TX 76104-2820

Phone

(817) 250-4906

NPI assigned

Oct 23, 2018

Sex

Male

Sole proprietor

No

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

Specialties & licenses 6

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: eetuokwu1496690@direct.texashealth.org

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

• Hallmark Healthcare LLC

  • Home Health Agency
  • Bedford, TX
  • NPI 1669635652

  5% Or Greater Direct Ownership Interest, W-2 Managing Employee

  CMS ownership

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.

• Texas Health Physicians Group

  • Internal Medicine Physician
  • Fort Worth, TX
  • NPI 1174573596
  Medicare reassignment NPD
• Texas Health Virtual Care

  • Internal Medicine Physician
  • Dallas, TX
  • NPI 1942951199

  Registered Nurse

  Medicare reassignment NPD
• Abc Caring Health Services, Inc

  • Home Health Agency
  • Bedford, TX
  • NPI 1548689177
  NPD Authorized official
• Hallmark Healthcare LLC

  • Home Health Agency
  • Bedford, TX
  • NPI 1669635652
  NPD Authorized official
• Texas Health Physicians Group

  • Sleep Disorder Diagnostic Clinic/Center
  • Fort Worth, TX
  • NPI 1114395969
  NPD
• Texas Health Physicians Group

  • Sleep Disorder Diagnostic Clinic/Center
  • Dallas, TX
  • NPI 1174992051
  NPD
• Texas Health Virtual Care

  • Psychiatry Physician
  • Mansfield, TX
  • NPI 1003507542
  NPD

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

{
    "created_epoch": "1540252800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1677715200000",
    "number": "1154897502",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1300 W TERRELL AVE STE K230",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761042820"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1300 W TERRELL AVE STE K230",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761042820",
            "telephone_number": "817-250-4906"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ETUOKWU",
        "first_name": "EMMANUEL",
        "credential": "AGNP-C, PMHNP-BC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-10-23",
        "last_updated": "2023-03-02",
        "certification_date": "2023-03-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "TX",
            "license": "AP139648",
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "TX",
            "license": "AP139648",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "TX",
            "license": "731092",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "TX",
            "license": "AP139648",
            "primary": false
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "TX",
            "license": "AP139648",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "TX",
            "license": "AP139648",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Raphna Etienne
• Seta Seta Etim
• Josephine Nzima Etta, APRN-PMHNP
• Gary Lee Etter, MD
• Alan Ettinger, DPM PA
• Briyet Sigala Eubanks, ATP
• Matthew Glenn Eubanks, LPC
• Eudaimonia Neurology PA
• Lyndi Jo Eudy, SLP
• Karina Euperio

• Adult Health Nurse Practitioner in Fort Worth, TX
• Providers in Fort Worth, TX by specialty
• Adult Health Nurse Practitioner in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 2, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.