Healthcare Provider Details

I. General information

NPI: 1396608972
Provider Name (Legal Business Name): JODELLE NZOKOU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/09/2025
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

181 E MAIN ST STE 4
WESTMINSTER MD
21157-6195
US

IV. Provider business mailing address

PO BOX 973
WESTMINSTER MD
21158-0973
US

V. Phone/Fax

Practice location:
  • Phone: 443-487-6681
  • Fax: 410-848-5629
Mailing address:
  • Phone: 443-487-6681
  • Fax: 410-848-5629

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR224445
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: