Provider Demographics
NPI:1356859276
Name:NGBODI, KATIE UWA (FNP)
Entity type:Individual
Prefix:MS
First Name:KATIE
Middle Name:UWA
Last Name:NGBODI
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:FISHKILL CORRECTIONAL FACILITY
Mailing Address - Street 2:18 STACK DRIVE
Mailing Address - City:BEACON
Mailing Address - State:NY
Mailing Address - Zip Code:12508
Mailing Address - Country:US
Mailing Address - Phone:845-831-4800
Mailing Address - Fax:
Practice Address - Street 1:FISHKILL CORRECTIONAL FACILILTY
Practice Address - Street 2:18 STRACK DRIVE
Practice Address - City:BEACON
Practice Address - State:NY
Practice Address - Zip Code:12508
Practice Address - Country:US
Practice Address - Phone:845-831-4800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-12
Last Update Date:2020-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY342229363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily