Healthcare Provider Details

I. General information

NPI: 1013363670
Provider Name (Legal Business Name): JESSE OKONIGBO NP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: JESSE OKONIGBO NP

II. Dates (important events)

Enumeration Date: 05/12/2016
Last Update Date: 03/11/2025
Certification Date: 03/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10440 LITTLE PATUXENT PKWY STE 300
COLUMBIA MD
21044-3648
US

IV. Provider business mailing address

10440 LITTLE PATUXENT PKWY STE 300
COLUMBIA MD
21044-3648
US

V. Phone/Fax

Practice location:
  • Phone: 240-702-3574
  • Fax:
Mailing address:
  • Phone: 240-702-3574
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LX0106X
TaxonomyOccupational Health Nurse Practitioner
License NumberR201977
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR201977
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR201977
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: