Provider Demographics
NPI:1275908444
Name:AKOH, THEOPHILUS MBI (NP)
Entity Type:Individual
Prefix:
First Name:THEOPHILUS
Middle Name:MBI
Last Name:AKOH
Suffix:
Gender:M
Credentials:NP
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Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2801 S VALLEY VIEW BLVD STE 8
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-0116
Mailing Address - Country:US
Mailing Address - Phone:775-335-7450
Mailing Address - Fax:725-223-4688
Practice Address - Street 1:4338 W THOMAS RD # U1
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85031-3878
Practice Address - Country:US
Practice Address - Phone:602-825-1613
Practice Address - Fax:602-825-1739
Is Sole Proprietor?:No
Enumeration Date:2015-12-14
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NVAPRN002085363LA2200X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health