Healthcare Provider Details

I. General information

NPI: 1184305062
Provider Name (Legal Business Name): MIRIAM OKOCHI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2023
Last Update Date: 11/20/2024
Certification Date: 11/17/2024
Deactivation Date: 06/24/2024
Reactivation Date: 07/05/2024

III. Provider practice location address

8656 W GAGE BLVD STE A106
KENNEWICK WA
99336-7145
US

IV. Provider business mailing address

8656 W GAGE BLVD STE A106
KENNEWICK WA
99336-7145
US

V. Phone/Fax

Practice location:
  • Phone: 509-778-0005
  • Fax:
Mailing address:
  • Phone: 509-778-0005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP61574493
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: