Healthcare Provider Details

I. General information

NPI: 1972373850
Provider Name (Legal Business Name): JENNIFER OKAGBARE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/03/2024
Last Update Date: 02/24/2026
Certification Date: 02/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

931 MATHER DR
BEAR DE
19701-4945
US

IV. Provider business mailing address

931 MATHER DR
BEAR DE
19701-4945
US

V. Phone/Fax

Practice location:
  • Phone: 225-323-3939
  • Fax:
Mailing address:
  • Phone: 225-323-3939
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberL8-0011008
License Number StateDE
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberLG-0012549
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: