Individual provider Active NPI

Charity Ifunanya Ejiakonye, NP

  • Family Nurse Practitioner
  • Dallas, TX
National Provider Identifier
1730567249
Registry record updated Jul 1, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
AP128148 Issued in TX
Practice address
4323 S Hampton Rd Apt 4225
Dallas, TX 75232-1058
Phone
(214) 331-6534
Fax
(214) 433-3046
NPI assigned
May 16, 2015
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 1, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Nurse Practitioner 363LP2300X AP128148 TX
Family Nurse Practitioner 363LF0000X AP128148 TX Primary

Addresses

Primary practice location

4323 S Hampton Rd Apt 4225
Dallas, TX 75232-1058

Mailing address

4323 S Hampton Rd Apt 4225
Dallas, TX 75232-1058
Phone (214) 331-6534

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20160913000188 TX Practitioner - Nurse Practitioner 0345536686

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
AP128148TXMDFamily Nurse Practitioner

NPI Registry JSON

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

{
    "created_epoch": "1431734400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1625097600000",
    "number": "1730567249",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4323 S HAMPTON RD APT 4225",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752321058",
            "telephone_number": "214-331-6534",
            "fax_number": "214-433-3046"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4323 S HAMPTON RD APT 4225",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752321058",
            "telephone_number": "214-331-6534",
            "fax_number": "214-433-3046"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EJIAKONYE",
        "first_name": "CHARITY",
        "middle_name": "IFUNANYA",
        "credential": "NP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-05-16",
        "last_updated": "2021-07-01",
        "certification_date": "2021-07-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "TX",
            "license": "AP128148",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TX",
            "license": "AP128148",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dallas, TX

Sources for this page

Verify at the official NPI Registry.