MEDICARE: NATHALIE K NDOKAME PMHNP-BC

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	R237383	MD

General Provider Information

NPI Number	:	1790561082
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NATHALIE K NDOKAME PMHNP-BC

Provider Business Mailing Address
First Line	:	8705A ARTHUR KNIGHT DR APT 202
Second Line	:
City	:	PERRY HALL
State	:	MD
Zip	:	21128-8037
Country	:	US
Telephone Number	:	443-985-6225
Fax Number	:

Provider Business Practice Location Address
First Line	:	1765 S 8TH ST
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80905-7910
Country	:	US
Telephone Number	:	719-900-1726
Fax Number	:

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

Provider Enumeration Date	:	09/04/2023
Last Update Date	:	01/05/2026

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