Provider Demographics
NPI:1316567175
Name:OKELLO, FENNY APONDI (FNP-C)
Entity Type:Individual
Prefix:
First Name:FENNY
Middle Name:APONDI
Last Name:OKELLO
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4254 PAULA DR
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27127-6820
Mailing Address - Country:US
Mailing Address - Phone:910-578-1665
Mailing Address - Fax:
Practice Address - Street 1:4254 PAULA DR
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27127-6820
Practice Address - Country:US
Practice Address - Phone:910-578-1665
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-22
Last Update Date:2020-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN293732363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
F02200245OtherCERTIFICATION NO