Provider Demographics
NPI:1366201568
Name:OGUNYE, JESSICA OKAFOR
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:OKAFOR
Last Name:OGUNYE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10450 SHAKER DR STE 110
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21046-2348
Mailing Address - Country:US
Mailing Address - Phone:202-867-1724
Mailing Address - Fax:
Practice Address - Street 1:820 KENNEDY ST NW UNIT 2
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20011-2973
Practice Address - Country:US
Practice Address - Phone:202-867-1724
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-18
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR226809363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health