Provider Demographics
NPI:1275012296
Name:KOFFI, EUNICE KULEMIA (NP)
Entity Type:Individual
Prefix:
First Name:EUNICE
Middle Name:KULEMIA
Last Name:KOFFI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19400 W BELLFORT ST APT 3214
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77407-8211
Mailing Address - Country:US
Mailing Address - Phone:281-975-8819
Mailing Address - Fax:
Practice Address - Street 1:12808 W AIRPORT BLVD STE 312
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-6223
Practice Address - Country:US
Practice Address - Phone:281-975-8819
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-09
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP136867363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology