Provider Demographics
NPI:1629670203
Name:KAKPO-MOORE, SENAN ISABELLE (PA-C)
Entity Type:Individual
Prefix:
First Name:SENAN
Middle Name:ISABELLE
Last Name:KAKPO-MOORE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:SENAN
Other - Middle Name:ISABELLE
Other - Last Name:KAKPO-MOORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:104 WOODMONT BLVD STE 500
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37205-2245
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12998 HESPERIA RD STE 204
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-8317
Practice Address - Country:US
Practice Address - Phone:760-780-4960
Practice Address - Fax:760-780-4964
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-10
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
CAPA60419363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant