Healthcare Provider Details

I. General information

NPI: 1083278030
Provider Name (Legal Business Name): GOLD EHIANETA OKOEKA MSN, APRN, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/25/2019
Last Update Date: 06/19/2020
Certification Date: 06/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

126 COVE ST
FALL RIVER MA
02720
US

IV. Provider business mailing address

126 COVE ST
FALL RIVER MA
02720-1357
US

V. Phone/Fax

Practice location:
  • Phone: 401-744-9947
  • Fax:
Mailing address:
  • Phone: 508-678-0041
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN56066
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN2311873
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN02128
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: