Healthcare Provider Details

I. General information

NPI: 1861201188
Provider Name (Legal Business Name): EFEROGHENE O OGHREIKANONE CCRN, FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/01/2025
Last Update Date: 01/01/2025
Certification Date: 01/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1638 OWEN DR
FAYETTEVILLE NC
28304-3424
US

IV. Provider business mailing address

9565 CLIFFDALE RD
FAYETTEVILLE NC
28304-5956
US

V. Phone/Fax

Practice location:
  • Phone: 910-615-4000
  • Fax:
Mailing address:
  • Phone: 804-605-8728
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2020020022
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: