MEDICARE: ADVANCED MEDICAL CENTER PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1083434963
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED MEDICAL CENTER PLLC

Provider Business Mailing Address
First Line	:	PO BOX 17365
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27116-7365
Country	:	US
Telephone Number	:	336-331-0978
Fax Number	:

Provider Business Practice Location Address
First Line	:	8025 N POINT BLVD STE 140
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27106-3753
Country	:	US
Telephone Number	:	336-331-0978
Fax Number	:	336-331-0979

Authorized Official
Title or Position	:	OWNER
Name	:	JUSTINA OKONKWO
Credential	:	DNP, PMHNP-BC, FNP-C
Telephone Number	:	336-414-1214

Provider Enumeration Date	:	10/15/2024
Last Update Date	:	12/12/2025

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