Provider Demographics
NPI:1700324316
Name:PAMELA MOKOKO, LLC
Entity Type:Organization
Organization Name:PAMELA MOKOKO, LLC
Other - Org Name:PRIMARY CARE & MENTAL HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:ENJEMA
Authorized Official - Last Name:MOKOKO
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP, FNP, APRN-BC
Authorized Official - Phone:912-224-1156
Mailing Address - Street 1:165 WILLOW OAK DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HILL
Mailing Address - State:GA
Mailing Address - Zip Code:31324-4069
Mailing Address - Country:US
Mailing Address - Phone:731-595-4433
Mailing Address - Fax:877-600-8393
Practice Address - Street 1:31285 TEMECULA PARKWAY
Practice Address - Street 2:STE 250
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92592
Practice Address - Country:US
Practice Address - Phone:912-224-1156
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-02
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN153499363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty