Healthcare Provider Details

I. General information

NPI: 1508604737
Provider Name (Legal Business Name): CHIKA C OKEOMA NP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2024
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3763 FETTLER PARK DR
DUMFRIES VA
22025-1946
US

IV. Provider business mailing address

18460 KERILL RD
TRIANGLE VA
22172-2082
US

V. Phone/Fax

Practice location:
  • Phone: 571-621-3202
  • Fax: 703-221-9191
Mailing address:
  • Phone: 571-621-3202
  • Fax: 703-221-9191

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number0024190728
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: