Provider Demographics
NPI:1568437648
Name:FOMENKY, YVONNE NKAFU (CNP, RHIA, RN)
Entity Type:Individual
Prefix:
First Name:YVONNE
Middle Name:NKAFU
Last Name:FOMENKY
Suffix:
Gender:F
Credentials:CNP, RHIA, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2336 MINERVA PARK PL
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43229-4770
Mailing Address - Country:US
Mailing Address - Phone:614-946-3022
Mailing Address - Fax:614-392-1083
Practice Address - Street 1:2336 MINERVA PARK PL
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43229-4770
Practice Address - Country:US
Practice Address - Phone:614-946-3022
Practice Address - Fax:614-392-1083
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-21
Last Update Date:2014-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN289586163W00000X
OHCOA.15966-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2300209Medicaid