Healthcare Provider Details

I. General information

NPI: 1891650867
Provider Name (Legal Business Name): NNENNA JUDITH CHUKWUYEM PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/22/2025
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 FRANK SCOTT PKWY W
BELLEVILLE IL
62223-5000
US

IV. Provider business mailing address

1027 SCENIC OAKS CT
IMPERIAL MO
63052-3457
US

V. Phone/Fax

Practice location:
  • Phone: 618-236-6501
  • Fax:
Mailing address:
  • Phone: 314-379-6818
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number2026000777
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: