Provider Demographics
NPI:1558910810
Name:KOKOU-ABI, KOMI AFANGNON (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:KOMI
Middle Name:AFANGNON
Last Name:KOKOU-ABI
Suffix:
Gender:M
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 N A W GRIMES BLVD STE 600
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78665-2745
Mailing Address - Country:US
Mailing Address - Phone:512-655-3104
Mailing Address - Fax:
Practice Address - Street 1:2200 N A W GRIMES BLVD STE 600
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78665-2745
Practice Address - Country:US
Practice Address - Phone:512-655-3104
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-10
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP143003363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health