Provider Demographics
NPI:1114746575
Name:OKEREKE, GOODLUCK CHIBUIKE (DNP)
Entity type:Individual
Prefix:DR
First Name:GOODLUCK
Middle Name:CHIBUIKE
Last Name:OKEREKE
Suffix:
Gender:M
Credentials:DNP
Other - Prefix:
Other - First Name:GOODLUCK
Other - Middle Name:C
Other - Last Name:OKEREKE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:GOODLUCK OKEREKE
Mailing Address - Street 1:9341 VANDERVOORT CT
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63126-5506
Mailing Address - Country:US
Mailing Address - Phone:314-437-1557
Mailing Address - Fax:
Practice Address - Street 1:6420 CLAYTON RD
Practice Address - Street 2:
Practice Address - City:RICHMOND HEIGHTS
Practice Address - State:MO
Practice Address - Zip Code:63117-1811
Practice Address - Country:US
Practice Address - Phone:314-768-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-03
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2024038542363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily