Healthcare Provider Details

I. General information

NPI: 1326585910
Provider Name (Legal Business Name): BERNADETTE NKECHI AKPENGBE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2017
Last Update Date: 02/13/2025
Certification Date: 02/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 N D ST STE 400
SAN BERNARDINO CA
92401-1715
US

IV. Provider business mailing address

4990 ARLINGTON AVE STE D
RIVERSIDE CA
92504-2757
US

V. Phone/Fax

Practice location:
  • Phone: 909-455-7571
  • Fax:
Mailing address:
  • Phone: 951-785-9011
  • Fax: 951-785-1436

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95005911
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number2022057900
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: