Provider Demographics
NPI:1639981384
Name:OUKO, KELVIN M
Entity type:Individual
Prefix:
First Name:KELVIN
Middle Name:M
Last Name:OUKO
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 1:4 FREEDOM CT
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:DE
Mailing Address - Zip Code:19720-3842
Mailing Address - Country:US
Mailing Address - Phone:302-476-4770
Mailing Address - Fax:
Practice Address - Street 1:4 FREEDOM CT
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:DE
Practice Address - Zip Code:19720-3842
Practice Address - Country:US
Practice Address - Phone:302-476-4770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-21
Last Update Date:2025-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE1701006347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle