Provider Demographics
NPI:1932668126
Name:COKER, FUNKE SOWEMIMO (APRN, PMHNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:FUNKE
Middle Name:SOWEMIMO
Last Name:COKER
Suffix:
Gender:F
Credentials:APRN, PMHNP-BC
Other - Prefix:
Other - First Name:OPEYEMI
Other - Middle Name:OLUFUNKE
Other - Last Name:IBIWOYE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5295 RIVER CHASE DRIVE
Mailing Address - Street 2:APARTMENT NUMBER 612
Mailing Address - City:PHENIX CITY
Mailing Address - State:AL
Mailing Address - Zip Code:36867
Mailing Address - Country:US
Mailing Address - Phone:678-650-4169
Mailing Address - Fax:
Practice Address - Street 1:3000 SCHATULGA RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31907-3117
Practice Address - Country:US
Practice Address - Phone:706-568-5202
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-18
Last Update Date:2019-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN214513363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health