MEDICARE: LUMINARA PSYCHIATRY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1437945607
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LUMINARA PSYCHIATRY

Provider Business Mailing Address
First Line	:	4210 ELECTRIC RD # 1178
Second Line	:
City	:	ROANOKE
State	:	VA
Zip	:	24018-0728
Country	:	US
Telephone Number	:	571-749-5447
Fax Number	:

Provider Business Practice Location Address
First Line	:	3441 BRANDON AVE SW
Second Line	:
City	:	ROANOKE
State	:	VA
Zip	:	24018-1516
Country	:	US
Telephone Number	:	571-749-5447
Fax Number	:

Authorized Official
Title or Position	:	PMHNP-BC
Name	:	OGECHI ANITA NKEONYE
Credential	:	APRN
Telephone Number	:	571-749-5447

Provider Enumeration Date	:	04/15/2025
Last Update Date	:	03/25/2026

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