Healthcare Provider Details

I. General information

NPI: 1720743479
Provider Name (Legal Business Name): NIKKY NNEKA OKONKWO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/07/2021
Last Update Date: 04/22/2025
Certification Date: 04/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3575 ARDEN WAY UNIT 2092
SACRAMENTO CA
95864-2911
US

IV. Provider business mailing address

5104 CHINA BERRY DR
MCKINNEY TX
75070-4671
US

V. Phone/Fax

Practice location:
  • Phone: 714-461-0746
  • Fax: 714-364-1081
Mailing address:
  • Phone: 972-201-6965
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95028747
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: