Provider Demographics
NPI:1629706577
Name:NKWONTA, NKEM O (PMHNP)
Entity Type:Individual
Prefix:
First Name:NKEM
Middle Name:O
Last Name:NKWONTA
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:NK
Other - Middle Name:O
Other - Last Name:NKWONTA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PMHNP
Mailing Address - Street 1:PO BOX 14123
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27709-4123
Mailing Address - Country:US
Mailing Address - Phone:844-744-7944
Mailing Address - Fax:
Practice Address - Street 1:3511 SHANNON RD # 341
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-6330
Practice Address - Country:US
Practice Address - Phone:844-744-7944
Practice Address - Fax:509-495-1145
Is Sole Proprietor?:No
Enumeration Date:2022-08-09
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5016677363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health