1013430974 NPI number — EKAETTE OGODO PMHNP

Table of content: EKAETTE OGODO PMHNP (NPI 1013430974)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013430974 NPI number — EKAETTE OGODO PMHNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OGODO
Provider First Name:
EKAETTE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PMHNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1013430974
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/11/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
385 CALLE DE ALEGRA BLDG A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAS CRUCES
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
88005-3423
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
575-526-1105
Provider Business Mailing Address Fax Number:
575-524-4266

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
PO BOX 2608
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DEMING
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
88031-2608
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
575-546-4800
Provider Business Practice Location Address Fax Number:
575-546-0685
Provider Enumeration Date:
07/24/2017

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LP0808X , with the licence number:  CNP-03459 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X , with the licence number: CNP-03459 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363LF0000X , with the licence number: 9295515 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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