MEDICARE: LUCY KELECHI UKACHUKWU

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	0024191557	VA

General Provider Information

NPI Number	:	1407677370
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUCY KELECHI UKACHUKWU

Provider Business Mailing Address
First Line	:	3611 BOULEVARD
Second Line	:
City	:	COLONIAL HEIGHTS
State	:	VA
Zip	:	23834-1344
Country	:	US
Telephone Number	:	701-989-2057
Fax Number	:

Provider Business Practice Location Address
First Line	:	3611 BOULEVARD
Second Line	:
City	:	COLONIAL HEIGHTS
State	:	VA
Zip	:	23834
Country	:	US
Telephone Number	:	804-391-0659
Fax Number	:	804-207-8884

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/22/2024
Last Update Date	:	06/17/2026

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