Provider Demographics
NPI:1649083213
Name:BOCKOR, KOFI MESSAN
Entity type:Individual
Prefix:MR
First Name:KOFI
Middle Name:MESSAN
Last Name:BOCKOR
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 1:16422 LILAC ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68116-3221
Mailing Address - Country:US
Mailing Address - Phone:402-779-9055
Mailing Address - Fax:
Practice Address - Street 1:3325 N 148TH CT APT 3206
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68116-7214
Practice Address - Country:US
Practice Address - Phone:402-650-3818
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-28
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide