Kodilim Anne Mukoso Okebalama, FNP-C

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

RN2291065 Issued in MA

Practice address

626 Southern Artery
Minuteclinic
Quincy, MA 02169-5648

Phone

(866) 389-2727

NPI assigned

Oct 7, 2015

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1444176000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1444176000000",
    "number": "1700257441",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "77 PRESIDENTIAL DR",
            "address_2": "#2",
            "city": "QUINCY",
            "state": "MA",
            "postal_code": "021698847",
            "telephone_number": "781-308-8028"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "626 SOUTHERN ARTERY",
            "address_2": "MINUTECLINIC",
            "city": "QUINCY",
            "state": "MA",
            "postal_code": "021695648",
            "telephone_number": "866-389-2727"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OKEBALAMA",
        "first_name": "KODILIM",
        "middle_name": "ANNE MUKOSO",
        "name_prefix": "Mrs.",
        "credential": "FNP-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-10-07",
        "last_updated": "2015-10-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MA",
            "license": "RN2291065",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Katrina Lynn Ogden
• Jennifer Ogle
• Meredith Joyce Oglevee
• Angelina N. Ojimba, B.A
• Hazuki Okamoto, MA
• Kasey Okeefe
• Joseph Obeng Okrah
• Oyindamola Olajide, RPH
• Olubunmi Olaide Olawale
• Margaret Olem, MSSW, LICSW

• Family Nurse Practitioner in Quincy, MA
• Providers in Quincy, MA by specialty
• Family Nurse Practitioner in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.