Basic Information
| Provider Information | |||||||||
| NPI: | 1588806244 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NKEMBE | ||||||||
| FirstName: | KWAMBA | ||||||||
| MiddleName: | EKWA | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 324 T B STANLEY HWY | ||||||||
| Address2: | |||||||||
| City: | BASSETT | ||||||||
| State: | VA | ||||||||
| PostalCode: | 240556108 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2766291076 | ||||||||
| FaxNumber: | 2766292695 | ||||||||
| Practice Location | |||||||||
| Address1: | 324 T B STANLEY HWY | ||||||||
| Address2: | |||||||||
| City: | BASSETT | ||||||||
| State: | VA | ||||||||
| PostalCode: | 240556108 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2766291076 | ||||||||
| FaxNumber: | 2766292695 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/27/2009 | ||||||||
| LastUpdateDate: | 10/27/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/27/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | 0101252583 | VA | Y | Allopathic & Osteopathic Physicians | General Practice |
No ID Information.