Provider Demographics
NPI:1124490438
Name:OKERE, IMMACULATA CHIMEZIE (NP)
Entity type:Individual
Prefix:
First Name:IMMACULATA
Middle Name:CHIMEZIE
Last Name:OKERE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:IMMACULATA
Other - Middle Name:CHIMEZIE
Other - Last Name:CHIKERE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:P.O BOX 26178
Mailing Address - Street 2:80 JESSE HILL JR. DRIVE SE
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30303
Mailing Address - Country:US
Mailing Address - Phone:404-616-6680
Mailing Address - Fax:
Practice Address - Street 1:56 JESSE HILL JR DRIVE
Practice Address - Street 2:
Practice Address - City:SOUTHEAST, ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30303
Practice Address - Country:US
Practice Address - Phone:404-616-6661
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-26
Last Update Date:2016-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN131127363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily