Healthcare Provider Details

I. General information

NPI: 1508309329
Provider Name (Legal Business Name): LUCYANNE OKWOMI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/28/2016
Last Update Date: 06/09/2025
Certification Date: 06/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8040 GEORGIA AVE STE 170
SILVER SPRING MD
20910-4959
US

IV. Provider business mailing address

13725 METCALF AVE STE 382
OVERLAND PARK KS
66223-7899
US

V. Phone/Fax

Practice location:
  • Phone: 202-360-4787
  • Fax:
Mailing address:
  • Phone: 913-648-8880
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number2007018588
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number2007018588
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAC007370
License Number StateMD
# 4
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number78074
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: