Provider Demographics
NPI:1346225794
Name:NWOKIKE, JEROME NWANNA (MD)
Entity Type:Individual
Prefix:DR
First Name:JEROME
Middle Name:NWANNA
Last Name:NWOKIKE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O.BOX 371531
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89137
Mailing Address - Country:US
Mailing Address - Phone:702-750-2438
Mailing Address - Fax:702-750-2173
Practice Address - Street 1:5105 CAMINO AL NORTE
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89031-2373
Practice Address - Country:US
Practice Address - Phone:702-750-2438
Practice Address - Fax:702-750-2173
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-08
Last Update Date:2014-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00592852084F0202X, 2084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084F0202XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyForensic Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry