Provider Demographics
NPI:1073261640
Name:OKEOWO, ABIDEMI (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:ABIDEMI
Middle Name:
Last Name:OKEOWO
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:ABIDEMI
Other - Middle Name:
Other - Last Name:OLUSHOLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6026 SIX FORKS RD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-3899
Mailing Address - Country:US
Mailing Address - Phone:919-865-8710
Mailing Address - Fax:919-977-9760
Practice Address - Street 1:5306 NC HIGHWAY 55 STE 105
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-7812
Practice Address - Country:US
Practice Address - Phone:919-457-1517
Practice Address - Fax:919-363-7697
Is Sole Proprietor?:No
Enumeration Date:2022-03-14
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC247983163W00000X
NC5015998363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse