Provider Demographics
NPI:1295448983
Name:NKEM, ELISABETH (LNMHP)
Entity type:Individual
Prefix:MRS
First Name:ELISABETH
Middle Name:
Last Name:NKEM
Suffix:
Gender:F
Credentials:LNMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12806 GLENDALE CT
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22407-2060
Mailing Address - Country:US
Mailing Address - Phone:571-409-8390
Mailing Address - Fax:
Practice Address - Street 1:6308 FIVE MILE CENTRE PARK STE 219
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22407-5508
Practice Address - Country:US
Practice Address - Phone:571-409-8390
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-28
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024186114363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA05Medicaid