Provider Demographics
NPI:1619660552
Name:KPIZING, AKOUAVI VIDEVA
Entity Type:Individual
Prefix:
First Name:AKOUAVI
Middle Name:VIDEVA
Last Name:KPIZING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2805 POND PL APT 2D
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10458-3657
Mailing Address - Country:US
Mailing Address - Phone:347-400-7494
Mailing Address - Fax:
Practice Address - Street 1:2805 POND PL APT 2D
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10458-3657
Practice Address - Country:US
Practice Address - Phone:347-400-7494
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-26
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF349860363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily