Provider Demographics
NPI:1164414512
Name:OKPALA, HENRIETTA OBY (DNP, PMHNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:HENRIETTA
Middle Name:OBY
Last Name:OKPALA
Suffix:
Gender:F
Credentials:DNP, PMHNP-BC
Other - Prefix:MRS
Other - First Name:HENRIETTA
Other - Middle Name:OBY
Other - Last Name:OKPALA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NPP
Mailing Address - Street 1:10536 AVENUE K
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11236-3018
Mailing Address - Country:US
Mailing Address - Phone:718-763-9323
Mailing Address - Fax:718-763-6082
Practice Address - Street 1:3005 CHURCH AVE STE E
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11226-4209
Practice Address - Country:US
Practice Address - Phone:347-627-6100
Practice Address - Fax:718-228-9641
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-20
Last Update Date:2020-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF400707363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY05143811Medicaid