Healthcare Provider Details

I. General information

NPI: 1952592156
Provider Name (Legal Business Name): JOSEPHINE NKECHI OKWECHIME MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2007
Last Update Date: 04/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1542 S DIXON RD
KOKOMO IN
46902-7318
US

IV. Provider business mailing address

1542 S DIXON RD
KOKOMO IN
46902-7318
US

V. Phone/Fax

Practice location:
  • Phone: 765-450-7314
  • Fax: 765-450-7316
Mailing address:
  • Phone: 765-450-7314
  • Fax: 765-450-7316

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number01052094A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: