Pedicare Childrens Clinic PA

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

P4362 Issued in TX

Legal business name

PEDICARE CHILDRENS CLINIC PA

Practice address

2101 N Midland Dr Ste 14a
Midland, TX 79707-5507

Phone

(432) 695-6300

Fax

(326) 956-5714

NPI assigned

Mar 23, 2017

Last updated

Feb 10, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Kingsley Okonkwo, MDNPI 1982732178

Title

President

Phone

(361) 334-0613

Specialties & licenses 3

Addresses

Other identifiers 3

Locations

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Kingsley C Okonkwo, M.D.

  • Pediatrics Physician
  • Odessa, TX
  • NPI 1982732178
  NPD (past) Authorized official
• Oluwatimilehin Daramola

  • Physician Assistant
  • Midland, TX
  • NPI 1881490738
  NPD
• Maria Briones

  • Physician Assistant
  • Odessa, TX
  • NPI 1992588586
  NPD (past)
• Karla Yesica Camara, FNP-C

  • Family Nurse Practitioner
  • Odessa, TX
  • NPI 1235913989
  NPD (past)
• Amy Diane Carrillo

  • Family Nurse Practitioner
  • Odessa, TX
  • NPI 1366082075
  NPD (past)
• Nicole Harris Grimes, APRN, FNP-C

  • Family Nurse Practitioner
  • Odessa, TX
  • NPI 1881346153
  NPD (past)
• Megan Elizabeth Lemond, NP

  • Family Nurse Practitioner
  • Baytown, TX
  • NPI 1235627605

  Pediatrics

  NPD (past)
• Kolawole Odumusi, M.D.

  • Pediatrics Physician
  • Odessa, TX
  • NPI 1518384973
  NPD (past)
• Oluwafunke C Ogunsola, FNP

  • Family Nurse Practitioner
  • Odessa, TX
  • NPI 1366362345
  NPD (past)
• Daniela Onzures, DNP, CPNP-PC

  • Pediatric Nurse Practitioner
  • Midland, TX
  • NPI 1760064877

  Pediatrics

  NPD (past)

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

{
    "created_epoch": "1490227200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1644451200000",
    "number": "1255862074",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2101 N MIDLAND DR STE 14A",
            "city": "MIDLAND",
            "state": "TX",
            "postal_code": "797075507",
            "telephone_number": "432-695-6300",
            "fax_number": "432-695-6571"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2101 N MIDLAND DR STE 14A",
            "city": "MIDLAND",
            "state": "TX",
            "postal_code": "797075507",
            "telephone_number": "432-695-6300",
            "fax_number": "326-956-5714"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6326 Yorktown Blvd Ste 1A",
            "address_purpose": "LOCATION",
            "city": "Corpus Christi",
            "state": "TX",
            "postal_code": "784145861",
            "country_code": "US",
            "telephone_number": "361-334-0613",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "912 E 5th St",
            "address_purpose": "LOCATION",
            "city": "Odessa",
            "state": "TX",
            "postal_code": "797614605",
            "country_code": "US",
            "telephone_number": "432-334-8845",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PEDICARE CHILDRENS CLINIC PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-03-23",
        "last_updated": "2022-02-10",
        "certification_date": "2022-02-10",
        "status": "A",
        "authorized_official_last_name": "OKONKWO",
        "authorized_official_first_name": "KINGSLEY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "361-334-0613",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "TX",
            "license": "Q5518",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "TX",
            "license": "P4362",
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ALL",
            "identifier": "AP144543",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "Q5518",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "P4362",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Michael Pawlowski, O.D.
• Jordan Payne
• Ashley Paz
• Peak Wilderness and Sports Medicine, PLLC
• Melissa Grossheim Peck, PHARM D
• Peds Center of Round Rock PA
• Peds in a Pod, PLLC.
• Jana Lynne Peikert, NNP-BS
• Victoria Angel Pena
• Kathlene Louise Pendleton, LCDC, LPC

• Pediatrics Physician in Midland, TX
• Providers in Midland, TX by specialty
• Pediatrics Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 10, 2022; 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.