Provider Demographics
NPI:1720743479
Name:OKONKWO, NIKKY NNEKA
Entity type:Individual
Prefix:
First Name:NIKKY
Middle Name:NNEKA
Last Name:OKONKWO
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5104 CHINA BERRY DR
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75070-4671
Mailing Address - Country:US
Mailing Address - Phone:972-201-6965
Mailing Address - Fax:
Practice Address - Street 1:3575 ARDEN WAY UNIT 2092
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95864-2911
Practice Address - Country:US
Practice Address - Phone:714-461-0746
Practice Address - Fax:714-364-1081
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-07
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95028747363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health