MEDICARE: GIFTY DOKU PMHNP/APRN

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	0024195195	VA

General Provider Information

NPI Number	:	1952279358
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GIFTY DOKU PMHNP/APRN

Provider Business Mailing Address
First Line	:	9051 RIBBON FALLS LOOP
Second Line	:
City	:	BRISTOW
State	:	VA
Zip	:	20136-6133
Country	:	US
Telephone Number	:	571-485-1044
Fax Number	:

Provider Business Practice Location Address
First Line	:	9051 RIBBON FALLS LOOP
Second Line	:
City	:	BRISTOW
State	:	VA
Zip	:	20136-6133
Country	:	US
Telephone Number	:	571-485-1044
Fax Number	:

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

Provider Enumeration Date	:	10/27/2025
Last Update Date	:	10/27/2025

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