Healthcare Provider Details

I. General information

NPI: 1467369421
Provider Name (Legal Business Name): EMMANUELA GINIKA OGBONNA DNP, APRN, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

655 MEDICAL PARK DR
AIKEN SC
29801-6415
US

IV. Provider business mailing address

655 MEDICAL PARK DR
AIKEN SC
29801-6415
US

V. Phone/Fax

Practice location:
  • Phone: 803-443-5724
  • Fax:
Mailing address:
  • Phone: 803-443-5724
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number259091
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: