Provider Demographics
NPI:1417412065
Name:CHENG-AKWA, GRISELDA MBONG (ARNP)
Entity Type:Individual
Prefix:
First Name:GRISELDA
Middle Name:MBONG
Last Name:CHENG-AKWA
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:553 GLEN ARVIN AVE
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40508-1069
Mailing Address - Country:US
Mailing Address - Phone:859-420-4668
Mailing Address - Fax:
Practice Address - Street 1:553 GLEN ARVIN AVE
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40508-1069
Practice Address - Country:US
Practice Address - Phone:859-420-4668
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-07
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3012854363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily