Healthcare Provider Details

I. General information

NPI: 1700324316
Provider Name (Legal Business Name): PAMELA MOKOKO, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2017
Last Update Date: 11/21/2023
Certification Date: 11/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31285 TEMECULA PARKWAY STE 250
TEMECULA CA
92592
US

IV. Provider business mailing address

165 WILLOW OAK DR
RICHMOND HILL GA
31324-4069
US

V. Phone/Fax

Practice location:
  • Phone: 912-224-1156
  • Fax:
Mailing address:
  • Phone: 731-595-4433
  • Fax: 877-600-8393

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN153499
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN153499
License Number StateGA

VIII. Authorized Official

Name: MRS. PAMELA ENJEMA MOKOKO
Title or Position: OWNER/CEO
Credential: PMHNP, FNP, APRN-BC
Phone: 912-224-1156