Provider Demographics
NPI:1326508797
Name:NKOL, BARIDUANEN BRIGHT (FNP)
Entity Type:Individual
Prefix:MR
First Name:BARIDUANEN
Middle Name:BRIGHT
Last Name:NKOL
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5060 N 19TH AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85015-3211
Mailing Address - Country:US
Mailing Address - Phone:602-702-6963
Mailing Address - Fax:
Practice Address - Street 1:5060 N 19TH AVE STE 102
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85015-3211
Practice Address - Country:US
Practice Address - Phone:602-702-6963
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-22
Last Update Date:2019-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ223407363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner