Healthcare Provider Details

I. General information

NPI: 1558064659
Provider Name (Legal Business Name): MRS. OBIOMA LINDA OKEKE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: OBIOMA LINDA EKEKEZIE PMHNP

II. Dates (important events)

Enumeration Date: 03/27/2023
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

53 NORWICH RD
BROCKTON MA
02302-2138
US

IV. Provider business mailing address

34 N PEARL ST
BROCKTON MA
02301-1708
US

V. Phone/Fax

Practice location:
  • Phone: 617-543-5448
  • Fax: 774-209-4367
Mailing address:
  • Phone: 617-543-5448
  • Fax: 774-209-4367

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN2330220
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN2330220
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: