Provider Demographics
NPI:1942921671
Name:AKPUNKU, NESTOR
Entity Type:Individual
Prefix:
First Name:NESTOR
Middle Name:
Last Name:AKPUNKU
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 382896
Mailing Address - Street 2:
Mailing Address - City:DUNCANVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75138-2896
Mailing Address - Country:US
Mailing Address - Phone:817-677-0750
Mailing Address - Fax:
Practice Address - Street 1:5338 W SWEET PEA TER
Practice Address - Street 2:
Practice Address - City:LAVEEN
Practice Address - State:AZ
Practice Address - Zip Code:85339-5429
Practice Address - Country:US
Practice Address - Phone:602-237-2760
Practice Address - Fax:602-237-7923
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-09
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X, 101YM0800X, 103TA0400X, 103TP0016X, 103TP0814X, 103TP2701X, 106S00000X, 171M00000X, 251B00000X, 251S00000X, 261QM0801X
TX1092621363LP0808X
AZ281220363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)
No103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)
No103TP0814XBehavioral Health & Social Service ProvidersPsychologistPsychoanalysis
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)