| Kelsom Clinic Pa | |
|
1202 W Pioneer Dr Suite 100 Irving TX 75061-7308 | |
| (972) 254-7272 | |
| (972) 254-7575 |
| Full Name | Kelsom Clinic Pa |
|---|---|
| Speciality | Family Medicine |
| Location | 1202 W Pioneer Dr, Irving, Texas |
| Authorized Official Name and Position | Catherine Okoronkwo (MD) |
| Authorized Official Contact | 9722547272 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Kelsom Clinic Pa 1202 W Pioneer Dr Suite 100 Irving TX 75061-7308 Ph: (972) 254-7272 | Kelsom Clinic Pa 1202 W Pioneer Dr Suite 100 Irving TX 75061-7308 Ph: (972) 254-7272 |
| NPI Number | 1104840594 |
|---|---|
| Provider Enumeration Date | 07/27/2006 |
| Last Update Date | 02/09/2011 |
| Medicare PECOS PAC ID | 1254391857 |
|---|---|
| Medicare Enrollment ID | O20050526000628 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104840594 | NPI | - | NPPES |
| 160977801 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | K2252 (Texas) | Primary |
| Provider Name | Catherine Okoronkwo |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1447343017 PECOS PAC ID: 3375644818 Enrollment ID: I20110207000390 |
| Provider Name | Biji Jiju |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1750612578 PECOS PAC ID: 0143351726 Enrollment ID: I20130927000044 |
| Provider Name | Leisel Sonia Mills |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1336534478 PECOS PAC ID: 7618298704 Enrollment ID: I20150601002151 |
| Provider Name | Sonija Shrestha |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1154779064 PECOS PAC ID: 4284922113 Enrollment ID: I20161010001551 |
| Provider Name | Patricia Emefiele |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1861987737 PECOS PAC ID: 6507016862 Enrollment ID: I20190122000329 |
| Provider Name | Bisharjana Kafle |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1770024218 PECOS PAC ID: 2668801788 Enrollment ID: I20200410000555 |
| Provider Name | Caroline Mwangi |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1346898780 PECOS PAC ID: 8527497601 Enrollment ID: I20200413000893 |
| Provider Name | Rudo Madondo Gwitira |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1396351474 PECOS PAC ID: 2961811690 Enrollment ID: I20210511000697 |
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