Individual provider Active NPI

Nkemdilim Okonkwo, PMHNP-BC

  • Psychiatric/Mental Health Nurse Practitioner
  • Laurel, MD
National Provider Identifier
1679174700
Registry record updated Aug 31, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
R240590 Issued in MD
Practice address
13922 Baltimore Ave
Laurel, MD 20707-5009
Phone
(301) 483-3333
NPI assigned
Nov 4, 2020
Last updated
Aug 31, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 31, 2023

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 R240590 MD Primary

Addresses

Primary practice location

13922 Baltimore Ave
Laurel, MD 20707-5009

Mailing address

7716 Cloister PL
Greenbelt, MD 20770-3029
Phone (301) 648-9593

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DC
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
I20240924000076 DC Practitioner - Nurse Practitioner 9234670845 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

5612 Paynes Endeavor Dr
Bowie, MD 20720-3380
Phone (240) 548-8426

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Vitality Mental and Behavior Health LLC CurrentSince Jun 30, 2024 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, 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": "1604448000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1693440000000",
    "number": "1679174700",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7716 CLOISTER PL",
            "city": "GREENBELT",
            "state": "MD",
            "postal_code": "207703029",
            "telephone_number": "301-648-9593"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13922 BALTIMORE AVE",
            "city": "LAUREL",
            "state": "MD",
            "postal_code": "207075009",
            "telephone_number": "301-483-3333"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OKONKWO",
        "first_name": "NKEMDILIM",
        "credential": "PMHNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-11-04",
        "last_updated": "2023-08-31",
        "certification_date": "2023-08-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "MD",
            "license": "R240590",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Laurel, MD

Sources for this page

Verify at the official NPI Registry.