Provider Demographics
NPI:1043922438
Name:NKEMNKIA, CHRISTIAN (NP)
Entity Type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:
Last Name:NKEMNKIA
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:439 STAPLEFORD LN
Mailing Address - Street 2:
Mailing Address - City:FUQUAY VARINA
Mailing Address - State:NC
Mailing Address - Zip Code:27526-1883
Mailing Address - Country:US
Mailing Address - Phone:248-719-2771
Mailing Address - Fax:
Practice Address - Street 1:10901 WORLD TRADE BLVD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27617-4203
Practice Address - Country:US
Practice Address - Phone:919-746-8900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-19
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5017377363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health