Healthcare Provider Details

I. General information

NPI: 1114746575
Provider Name (Legal Business Name): GOODLUCK CHIBUIKE OKEREKE DNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: GOODLUCK C OKEREKE GOODLUCK OKEREKE

II. Dates (important events)

Enumeration Date: 10/03/2024
Last Update Date: 08/15/2025
Certification Date: 08/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4801 WELDON SPRING PKWY
WELDON SPRING MO
63304-9101
US

IV. Provider business mailing address

PO BOX 1449
MARYLAND HEIGHTS MO
63043-0449
US

V. Phone/Fax

Practice location:
  • Phone: 800-345-5407
  • Fax: 636-386-5386
Mailing address:
  • Phone: 314-437-1557
  • Fax: 636-386-5386

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2024038542
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: