Healthcare Provider Details

I. General information

NPI: 1639058043
Provider Name (Legal Business Name): EKEOMA OKOROAFOR PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2025
Last Update Date: 08/29/2025
Certification Date: 08/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14440 CHERRY LANE CT STE 201A
LAUREL MD
20707-4946
US

IV. Provider business mailing address

2506 STONE MANOR DR
BOWIE MD
20721-1881
US

V. Phone/Fax

Practice location:
  • Phone: 240-755-5117
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR193229
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: