=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306985395
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | OKEE EKENNA, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/06/2007
-----------------------------------------------------
Last Update Date | 01/18/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3702 JEFFERSON AVE
-----------------------------------------------------
City | PASCAGOULA
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39563-6218
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 228-769-2588
-----------------------------------------------------
Fax | 228-769-2589
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3702 JEFFERSON AVE
-----------------------------------------------------
City | PASCAGOULA
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39563-6218
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 228-769-2588
-----------------------------------------------------
Fax | 228-769-2589
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. OKECHUKWU EKENNA
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 228-769-2588
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RI0200X
-----------------------------------------------------
Taxonomy Name | Infectious Disease Physician
-----------------------------------------------------
License Number | 13816
-----------------------------------------------------
License Number State | MS
-----------------------------------------------------