MEDICARE: IJEOMA JENNIFER OKEH FNP-C, PMHNP

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	RN213830	GA
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	10026166	OR
3	363LF0000X	Family Nurse Practitioner	APRN-NP213830	GA

General Provider Information

NPI Number	:	1578933230
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IJEOMA JENNIFER OKEH FNP-C, PMHNP

Provider Business Mailing Address
First Line	:	215 MARVIN MILLER DR SW # 123
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30336-1813
Country	:	US
Telephone Number	:	678-849-5774
Fax Number	:

Provider Business Practice Location Address
First Line	:	215 MARVIN MILLER DR SW STE 123
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30336-1813
Country	:	US
Telephone Number	:	678-849-5774
Fax Number	:

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

Provider Enumeration Date	:	10/06/2015
Last Update Date	:	05/06/2026

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