Individual provider Active NPI

Emmanuel Onyeani

  • Psychiatric/Mental Health Nurse Practitioner
  • Phoenix, AZ
National Provider Identifier
1194215673
Registry record updated Jul 19, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
256918 Issued in AZ
Practice address
29675 N North Valley Pkwy Unit 1077
Phoenix, AZ 85085-0783
Phone
(404) 447-0127
NPI assigned
May 10, 2018
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 19, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X RN263120 GA
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 256918 AZ Primary

Addresses

Primary practice location

29675 N North Valley Pkwy Unit 1077
Phoenix, AZ 85085-0783

Mailing address

1291 Stanley Rd NW
Kennesaw, GA 30152-4359
Phone (770) 427-0147

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
RN263120GAMDRegistered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Desert Tranquility Integrated Wellness Services LLC Current Accepting new patients
RF Ramirez LLC CurrentSince May 1, 2024 Accepting new patients
Grande Integrated Wellness Solutions LLC Past Accepting new patients

Locations

3430 E Flamingo Rd
Ste 100
Las Vegas, NV 89121
Phone (702) 444-4690

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1525910400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1626652800000",
    "number": "1194215673",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1291 STANLEY RD NW",
            "city": "KENNESAW",
            "state": "GA",
            "postal_code": "301524359",
            "telephone_number": "770-427-0147"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "29675 N NORTH VALLEY PKWY UNIT 1077",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850850783",
            "telephone_number": "404-447-0127"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ONYEANI",
        "first_name": "EMMANUEL",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-05-10",
        "last_updated": "2021-07-19",
        "certification_date": "2021-07-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "GA",
            "license": "RN263120",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "AZ",
            "license": "256918",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Phoenix, AZ

Sources for this page

Verify at the official NPI Registry.