Basic Information
| Provider Information | |||||||||
| NPI: | 1194288332 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | AKAN | ||||||||
| FirstName: | EDAK | ||||||||
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| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6030 W UNIVERSITY BLVD | ||||||||
| Address2: | |||||||||
| City: | ODESSA | ||||||||
| State: | TX | ||||||||
| PostalCode: | 797648530 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4326406600 | ||||||||
| FaxNumber: | 4326404791 | ||||||||
| Practice Location | |||||||||
| Address1: | 6030 W UNIVERSITY BLVD | ||||||||
| Address2: | |||||||||
| City: | ODESSA | ||||||||
| State: | TX | ||||||||
| PostalCode: | 797648530 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4326406600 | ||||||||
| FaxNumber: | 4326404791 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/12/2019 | ||||||||
| LastUpdateDate: | 02/03/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 02/03/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | AP139792 | TX | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.