Individual provider Active NPI

Olivia Ngozi Mgbeokwere, MS, FNP-C

  • Family Nurse Practitioner
  • Fort Stewart, GA
National Provider Identifier
1851625602
Registry record updated Jul 23, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
RN 113001 NP Issued in GA
Practice address
1061 Harmon Ave
Ste 1D03
Fort Stewart, GA 31314-5641
Phone
(912) 435-6633
NPI assigned
Sep 28, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 23, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X RN 113001 NP GA Primary

Addresses

Primary practice location

1061 Harmon Ave
Ste 1D03
Fort Stewart, GA 31314-5641

Mailing address

1670 Clairmont Rd
Ste 5
Decatur, GA 30033-4004
Phone (404) 321-6111

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
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
I20120712000217 GA Order and Referring Only - Nurse Practitioner 2668637943

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science

State licenses

LicenseStateTypeSpecialty
RN 113001 NPGAMDFamily Nurse Practitioner

NPI Registry JSON

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

{
    "created_epoch": "1254096000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1374537600000",
    "number": "1851625602",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1670 CLAIRMONT RD",
            "address_2": "STE 5",
            "city": "DECATUR",
            "state": "GA",
            "postal_code": "300334004",
            "telephone_number": "404-321-6111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1061 HARMON AVE",
            "address_2": "STE 1D03",
            "city": "FORT STEWART",
            "state": "GA",
            "postal_code": "313145641",
            "telephone_number": "912-435-6633"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MGBEOKWERE",
        "first_name": "OLIVIA",
        "middle_name": "NGOZI",
        "name_prefix": "Mrs.",
        "credential": "MS, FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-09-28",
        "last_updated": "2013-07-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "GA",
            "license": "RN 113001 NP",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Stewart, GA

Sources for this page

Verify at the official NPI Registry.