Healthcare Provider Details

I. General information

NPI: 1407677370
Provider Name (Legal Business Name): LUCY KELECHI UKACHUKWU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/22/2024
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3611 BOULEVARD
COLONIAL HEIGHTS VA
23834
US

IV. Provider business mailing address

3611 BOULEVARD
COLONIAL HEIGHTS VA
23834-1344
US

V. Phone/Fax

Practice location:
  • Phone: 804-391-0659
  • Fax: 804-207-8884
Mailing address:
  • Phone: 701-989-2057
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number0024191557
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: