Provider Demographics
NPI:1467166785
Name:POKRYWA, KENZA M (PA-C)
Entity Type:Individual
Prefix:
First Name:KENZA
Middle Name:M
Last Name:POKRYWA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KENZA
Other - Middle Name:
Other - Last Name:MAGOUH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:4119 BROWNS LN
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40220-1500
Mailing Address - Country:US
Mailing Address - Phone:502-451-9296
Mailing Address - Fax:
Practice Address - Street 1:4119 BROWNS LN
Practice Address - Street 2:STE 1
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40220-1500
Practice Address - Country:US
Practice Address - Phone:502-451-9296
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-11
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPA3167363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant