Healthcare Provider Details

I. General information

NPI: 1982198230
Provider Name (Legal Business Name): BERNICE OGOLA PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2018
Last Update Date: 04/24/2025
Certification Date: 04/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11518 N FRONTAGE RD
YUMA AZ
85367-8994
US

IV. Provider business mailing address

PO BOX 669
YUMA AZ
85366-2329
US

V. Phone/Fax

Practice location:
  • Phone: 928-342-6500
  • Fax:
Mailing address:
  • Phone: 520-476-3503
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number726556
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number320202
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: