Healthcare Provider Details

I. General information

NPI: 1760660112
Provider Name (Legal Business Name): PAMELA TEGEMAH NKWENTI PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/07/2008
Last Update Date: 07/07/2020
Certification Date: 07/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6963 COSIMO LN
PICKERINGTON OH
43147-7715
US

IV. Provider business mailing address

6963 COSIMO LN
PICKERINGTON OH
43147-7715
US

V. Phone/Fax

Practice location:
  • Phone: 614-377-3391
  • Fax:
Mailing address:
  • Phone: 614-377-3391
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number2020011235
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN338197
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: