MEDICARE: MR. KELVIN CHINAKWE OKWUDIOGOR NURSE PRACTITIONER

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	NP1047502	DC

General Provider Information

NPI Number	:	1407695646
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. KELVIN CHINAKWE OKWUDIOGOR NURSE PRACTITIONER

Provider Business Mailing Address
First Line	:	3200 CRAIN HWY STE 102
Second Line	:
City	:	WALDORF
State	:	MD
Zip	:	20603-4841
Country	:	US
Telephone Number	:	240-478-2266
Fax Number	:

Provider Business Practice Location Address
First Line	:	3200 CRAIN HWY STE 102
Second Line	:
City	:	WALDORF
State	:	MD
Zip	:	20603-4841
Country	:	US
Telephone Number	:	240-478-2266
Fax Number	:

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

Provider Enumeration Date	:	05/20/2024
Last Update Date	:	02/06/2026

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