Provider Demographics
NPI:1265116750
Name:PAKA, JOJO KIENGA (NP)
Entity type:Individual
Prefix:
First Name:JOJO
Middle Name:KIENGA
Last Name:PAKA
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:JOJO
Other - Middle Name:
Other - Last Name:PAKA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:103 MEMORIAL CT
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:NC
Mailing Address - Zip Code:27520-4222
Mailing Address - Country:US
Mailing Address - Phone:919-670-6723
Mailing Address - Fax:
Practice Address - Street 1:1449 FREEWAY DR STE F
Practice Address - Street 2:
Practice Address - City:REIDSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27320-7122
Practice Address - Country:US
Practice Address - Phone:336-280-0595
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-14
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024187580363LP0808X
NC5018253363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health