Healthcare Provider Details

I. General information

NPI: 1477994887
Provider Name (Legal Business Name): MS. TESSY OKOBOKEKEIMEI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2013
Last Update Date: 10/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2041 GEORGIA AVE NW
WASHINGTON DC
20060-4610
US

IV. Provider business mailing address

7605 NEWBURG DR
LANHAM MD
20706-4610
US

V. Phone/Fax

Practice location:
  • Phone: 202-865-3290
  • Fax:
Mailing address:
  • Phone: 301-552-0168
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2013011989
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN1002263
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: