MEDICARE: NKEM O NKWONTA PMHNP

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	281753	AZ
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	5016677	NC

General Provider Information

NPI Number	:	1629706577
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NKEM O NKWONTA PMHNP

Provider Business Mailing Address
First Line	:	PO BOX 14123
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27709-4123
Country	:	US
Telephone Number	:	844-744-7944
Fax Number	:

Provider Business Practice Location Address
First Line	:	3511 SHANNON RD # 341
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27707-6330
Country	:	US
Telephone Number	:	844-744-7944
Fax Number	:	509-495-1145

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/09/2022
Last Update Date	:	06/03/2025

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