Healthcare Provider Details

I. General information

NPI: 1578707543
Provider Name (Legal Business Name): GLORY DICKSON EKANEM PMHNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/21/2009
Last Update Date: 10/07/2025
Certification Date: 10/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2085 CITYGATE DR
COLUMBUS OH
43219-3656
US

IV. Provider business mailing address

3287 BIDLINGTON DR
COLUMBUS OH
43224-5716
US

V. Phone/Fax

Practice location:
  • Phone: 614-300-9100
  • Fax:
Mailing address:
  • Phone: 614-598-7300
  • Fax: 614-598-7300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberLE00059564
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberRN407523
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: