Individual provider Active NPI

Ivy Okonkwo

  • Psychiatric/Mental Health Nurse Practitioner
  • Port Angeles, WA
National Provider Identifier
1619452430
Registry record updated Jun 26, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
AP61691586 Issued in WA
Practice address
118 E 8TH St
Port Angeles, WA 98362-6129
Phone
(360) 457-0431
Fax
(360) 457-0493
NPI assigned
Sep 27, 2018
Last updated
Jun 26, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 26, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X AP61691586 WA Primary

Addresses

Primary practice location

118 E 8TH St
Port Angeles, WA 98362-6129

Mailing address

118 E 8TH St
Port Angeles, WA 98362-6129
Phone (360) 457-0431

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
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
I20250819004607 WA Practitioner - Nurse Practitioner 7315446945 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2024
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

118 E 8TH St
Port Angeles, WA 98362-6129

6505 216TH St SW
Suite 100
Mountlake Terrace, WA 98043-2089

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
AP61691586WAMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Peninsula Behavioral Health CurrentSince Jun 23, 2025 Accepting new patients
Mindful Therapy Group PC Psychiatric/Mental Health CurrentSince Sep 16, 2025 Accepting new patients

Locations

6505 216th St SW
Ste 100
Mountlake Terrace, WA 98043
Phone (425) 678-6463

21907 64th Ave W
Ste 200
Mountlake Terrace, WA 98043
Phone (410) 258-3698

118 E 8th St
Port Angeles, WA 98362
Phone (360) 457-0431

320 NE 97th St
Ste A
Seattle, WA 98115
Phone (206) 323-8113

201 W North River Dr
Ste 301
Spokane, WA 99201
Phone (509) 405-5504

Interoperability endpoints

  • FHIR API: https://api.qualifacts.org/api/fhir/peninsulabehavioral/r4/

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": "1538006400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1750896000000",
    "number": "1619452430",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "118 E 8TH ST",
            "city": "PORT ANGELES",
            "state": "WA",
            "postal_code": "983626129",
            "telephone_number": "360-457-0431",
            "fax_number": "360-457-0493"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "118 E 8TH ST",
            "city": "PORT ANGELES",
            "state": "WA",
            "postal_code": "983626129",
            "telephone_number": "360-457-0431",
            "fax_number": "360-457-0493"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OKONKWO",
        "first_name": "IVY",
        "name_prefix": "Ms.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-09-27",
        "last_updated": "2025-06-26",
        "certification_date": "2025-06-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "WA",
            "license": "AP61691586",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Port Angeles, WA

Sources for this page

Verify at the official NPI Registry.