Provider Demographics
NPI:1427948223
Name:KOUACOU-KLA, ANDY
Entity type:Individual
Prefix:
First Name:ANDY
Middle Name:
Last Name:KOUACOU-KLA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1921 BEECHAM CT
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20721-2705
Mailing Address - Country:US
Mailing Address - Phone:240-988-0116
Mailing Address - Fax:
Practice Address - Street 1:7211 PARK HEIGHTS AVE STE 4
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21208-5497
Practice Address - Country:US
Practice Address - Phone:240-486-0357
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-04
Last Update Date:2025-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator