Provider Demographics
NPI:1659142958
Name:ASKUWHETEAU, PACHUA
Entity Type:Individual
Prefix:
First Name:PACHUA
Middle Name:
Last Name:ASKUWHETEAU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4486
Mailing Address - Street 2:
Mailing Address - City:BROOKHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:39603-6486
Mailing Address - Country:US
Mailing Address - Phone:601-550-7403
Mailing Address - Fax:
Practice Address - Street 1:1679 MAGNOLIA DR
Practice Address - Street 2:
Practice Address - City:PRENTISS
Practice Address - State:MS
Practice Address - Zip Code:39474-9008
Practice Address - Country:US
Practice Address - Phone:601-550-7403
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-15
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA343900000X, 344600000X
MS344600000X, 343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No344600000XTransportation ServicesTaxi