Provider Demographics
NPI:1023631157
Name:NKONGHO, CATHERINE A (NP)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:A
Last Name:NKONGHO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:437 CONCORD CIR
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253-8001
Mailing Address - Country:US
Mailing Address - Phone:240-491-6813
Mailing Address - Fax:
Practice Address - Street 1:437 CONCORD CIR
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253-8001
Practice Address - Country:US
Practice Address - Phone:240-491-6813
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-23
Last Update Date:2020-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN245232363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily