Provider Demographics
NPI:1649314196
Name:OKPOKHO, NGOHIDE GLADYS
Entity type:Individual
Prefix:
First Name:NGOHIDE
Middle Name:GLADYS
Last Name:OKPOKHO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 23813
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40523-3813
Mailing Address - Country:US
Mailing Address - Phone:859-977-0125
Mailing Address - Fax:
Practice Address - Street 1:1450 N BROADWAY
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40505-3162
Practice Address - Country:US
Practice Address - Phone:859-977-0125
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-1629133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYRD00014Medicare ID - Type UnspecifiedREGISTERED DIETITIAN