IndividualActive
Oluwakemisola Koku
NPI 1619812427 · Child & Adolescent Psychiatric/Mental Health Clinical Nurse Specialist · Waldorf, MD
Provider details
- NPI number
- 1619812427
- Entity type
- Individual
- Primary specialty
- Child & Adolescent Psychiatric/Mental Health Clinical Nurse SpecialistPhysician Assistants & Advanced Practice Nursing Providers
- Sex
- Female
- Sole proprietor
- No
- License
- 1025926 (TX)
Specialties & taxonomies
- Child & Adolescent Psychiatric/Mental Health Clinical Nurse SpecialistPrimary364SP0807XLicense 1025926 (TX)
Physician Assistants & Advanced Practice Nursing Providers
Practice location
4665 Pebble Beach Ct
Waldorf, MD 20602-4110
Phone: (737) 268-9101
Approximate (ZIP-level) locationGet directions
Mailing address
4665 Pebble Beach Ct
Waldorf, MD 20602-4110
Registry dates
- Enumerated
- 2026-04-20
- Last updated
- 2026-04-20
- Certified
- 2026-04-20
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.