Individual provider Active NPI

Nkechi E Nwachukwu, FNP

  • Nurse Practitioner
  • Dedham, MA
National Provider Identifier
1497452783
Registry record updated Sep 29, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
RN2263205 Issued in MA
Practice address
55 Clisby Ave
Dedham, MA 02026-2114
Phone
(617) 281-6572
NPI assigned
Feb 8, 2023
Last updated
Sep 29, 2025By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 29, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse PractitionerGroup: 193400000X SINGLE SPECIALTY GROUP 363L00000X RN2263205 MA Primary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X RN2263205 MA

Addresses

Primary practice location

55 Clisby Ave
Dedham, MA 02026-2114

Mailing address

55 Clisby Ave
Dedham, MA 02026-2114
Phone (617) 281-6572

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240911003482 MA Practitioner - Nurse Practitioner 6406396837 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Supportive Behavioral Care of Ma LLCGroup PAC ID 8628346731, 103 clinicians

Practice addresses (Care Compare)

44 School St
RM 325
Boston, MA 02108-4209
Phone (718) 298-4375

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
RN2263205MAMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Supportive Behavioral Care of Ma LLC Single Specialty CurrentSince Aug 15, 2024 Accepting new patients

Locations

44 School St
Rm 325
Boston, MA 02108
Phone (508) 831-8558

27 Randolph Rd
Howell, NJ 07731
Phone (972) 677-7951

Organizations & group practices 2

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

NPI Registry JSON

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

{
    "created_epoch": "1675814400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1759104000000",
    "number": "1497452783",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "55 CLISBY AVE",
            "city": "DEDHAM",
            "state": "MA",
            "postal_code": "020262114",
            "telephone_number": "617-281-6572"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "55 CLISBY AVE",
            "city": "DEDHAM",
            "state": "MA",
            "postal_code": "020262114",
            "telephone_number": "617-281-6572"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NWACHUKWU",
        "first_name": "NKECHI",
        "middle_name": "E",
        "credential": "FNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-02-08",
        "last_updated": "2025-09-29",
        "certification_date": "2025-09-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner",
            "state": "MA",
            "license": "RN2263205",
            "primary": true
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "MA",
            "license": "RN2263205",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dedham, MA

Sources for this page

Verify at the official NPI Registry.