Provider Demographics
NPI:1437945607
Name:LUMINARA PSYCHIATRY
Entity type:Organization
Organization Name:LUMINARA PSYCHIATRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PMHNP-BC
Authorized Official - Prefix:
Authorized Official - First Name:OGECHI
Authorized Official - Middle Name:ANITA
Authorized Official - Last Name:NKEONYE
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:571-749-5447
Mailing Address - Street 1:4210 ELECTRIC RD # 1178
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-0728
Mailing Address - Country:US
Mailing Address - Phone:571-749-5447
Mailing Address - Fax:
Practice Address - Street 1:3441 BRANDON AVE SW
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-1516
Practice Address - Country:US
Practice Address - Phone:571-749-5447
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-15
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty