Provider Demographics
NPI:1891263190
Name:EKENGA, JOY UGONMA (FNP)
Entity Type:Individual
Prefix:
First Name:JOY
Middle Name:UGONMA
Last Name:EKENGA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1240 SAINT PATRICE LN
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63031-7926
Mailing Address - Country:US
Mailing Address - Phone:314-922-3128
Mailing Address - Fax:
Practice Address - Street 1:1240 SAINT PATRICE LN
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63031-7926
Practice Address - Country:US
Practice Address - Phone:314-922-3128
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-05
Last Update Date:2018-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018031756363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily