Basic Information
| Provider Information | |||||||||
| NPI: | 1306204870 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | AKUOKO | ||||||||
| FirstName: | NANA | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5156 NC HIGHWAY 42 W | ||||||||
| Address2: | |||||||||
| City: | GARNER | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275298417 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9193295000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 454 MAPLE AVE | ||||||||
| Address2: | |||||||||
| City: | SARATOGA SPRINGS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 128665532 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5185871141 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/29/2016 | ||||||||
| LastUpdateDate: | 12/09/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/09/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | NY | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363A00000X | 019481 | NY | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363A00000X | 06924 | NC | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | 04397279 | 05 | NY | MEDICAID |