Healthcare Provider Details

I. General information

NPI: 1952238073
Provider Name (Legal Business Name): EDVERA INTEGRATIVE PSYCHIATRY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2026
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 DACULA RD STE 4A-266
DACULA GA
30019-7061
US

IV. Provider business mailing address

710 DACULA RD STE 4A-266
DACULA GA
30019-7061
US

V. Phone/Fax

Practice location:
  • Phone: 919-396-1693
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: EDWARD OKEKE
Title or Position: NURSE PRACTITIONER
Credential: MSN, APRN, PMHNP-BC
Phone: 919-396-1693