Provider Demographics
NPI:1962050187
Name:NKEMASONG, BEBONGCHU (MSN, APRN,PMHNP-BC)
Entity type:Individual
Prefix:
First Name:BEBONGCHU
Middle Name:
Last Name:NKEMASONG
Suffix:
Gender:F
Credentials:MSN, APRN,PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1649 BRICE RD STE A
Mailing Address - Street 2:
Mailing Address - City:REYNOLDSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43068-2796
Mailing Address - Country:US
Mailing Address - Phone:614-812-0415
Mailing Address - Fax:614-812-0432
Practice Address - Street 1:6100 CHANNINGWAY BLVD STE 508
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43232-2910
Practice Address - Country:US
Practice Address - Phone:614-812-0415
Practice Address - Fax:614-812-0432
Is Sole Proprietor?:No
Enumeration Date:2019-08-30
Last Update Date:2021-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.025135363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health