Provider Demographics
NPI:1538690920
Name:OGWUDILE, EMEKA JACOB (APRN-CNP)
Entity Type:Individual
Prefix:
First Name:EMEKA
Middle Name:JACOB
Last Name:OGWUDILE
Suffix:
Gender:M
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14913 GRAND SUMMIT BLVD
Mailing Address - Street 2:APT 101
Mailing Address - City:GRANDVIEW
Mailing Address - State:MO
Mailing Address - Zip Code:64030-2482
Mailing Address - Country:US
Mailing Address - Phone:816-585-2666
Mailing Address - Fax:
Practice Address - Street 1:2600 E 12TH ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64127-1321
Practice Address - Country:US
Practice Address - Phone:816-965-1100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017007164363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health