Active NPI
Eghosa Odobo
- Family Nurse Practitioner
- North Las Vegas, NV
National Provider Identifier
1346653508
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- RN201454
- Practice address
- 6900 Pecos Rd
North Las Vegas, NV 89086-4400 - Phone
- (702) 791-9000
- NPI assigned
- Jun 5, 2014
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | RN201454 | GA | Primary |
Addresses
Primary practice location
6900 Pecos Rd
North Las Vegas, NV 89086-4400
Mailing address
903 Shaftoe St NW
Kennesaw, GA 30152-6999
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RN201454 | GA | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Divine Healthcare | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Home Health Agency
- Kennesaw, GA
- NPI 1255618716
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1401926400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1402444800000",
"number": "1346653508",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "903 SHAFTOE ST NW",
"city": "KENNESAW",
"state": "GA",
"postal_code": "301526999"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6900 PECOS RD",
"city": "NORTH LAS VEGAS",
"state": "NV",
"postal_code": "890864400",
"telephone_number": "702-791-9000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ODOBO",
"first_name": "EGHOSA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2014-06-05",
"last_updated": "2014-06-11",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "GA",
"license": "RN201454",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in North Las Vegas, NV
- Suzanne K Ocariza, P.T.
- Occupational Health Centers of the Southwest, P.a.
- Occupational Health Centers of the Southwest, P.a.
- Jorge David Oceguera
- Effiejane Ochoa-Carrasco, PTA
- Mary Jeanette Mojica Odtohan-Mesa, M.D.
- Shawn Mojica Odtohan, MD
- Mary Catherine Oechslin, APRN
- Ogifi Behavioral Health Services Inc
- Ijeoma Ohadugha, MD, MSPH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.