Healthcare Provider Details

I. General information

NPI: 1053982553
Provider Name (Legal Business Name): CHIZIMUZO CHINONSO TOCHUKWU OKOLI PHD, MPH, APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2021
Last Update Date: 07/06/2021
Certification Date: 07/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1350 BULL LEA RD
LEXINGTON KY
40511-1247
US

IV. Provider business mailing address

612 BEECHMONT RD
LEXINGTON KY
40502-2836
US

V. Phone/Fax

Practice location:
  • Phone: 859-246-8020
  • Fax:
Mailing address:
  • Phone: 859-866-8508
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number3016115
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: