Provider Demographics
NPI:1073670469
Name:AKINFENWA, KEHINDE ADEKOYEJO (LPT)
Entity Type:Individual
Prefix:MR
First Name:KEHINDE
Middle Name:ADEKOYEJO
Last Name:AKINFENWA
Suffix:
Gender:M
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1006 DICKERSON DR
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:TX
Mailing Address - Zip Code:75951-5111
Mailing Address - Country:US
Mailing Address - Phone:409-383-5200
Mailing Address - Fax:409-383-5202
Practice Address - Street 1:1006 DICKERSON DR
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:TX
Practice Address - Zip Code:75951-5111
Practice Address - Country:US
Practice Address - Phone:409-383-5200
Practice Address - Fax:409-383-5202
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1144418363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical