Provider Demographics
NPI:1932442183
Name:NKETIAH, KWAME
Entity Type:Individual
Prefix:MR
First Name:KWAME
Middle Name:
Last Name:NKETIAH
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:KWAME
Other - Middle Name:
Other - Last Name:NKETIA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:12831 STRATFORD DR APT 190
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-8484
Mailing Address - Country:US
Mailing Address - Phone:405-371-2293
Mailing Address - Fax:
Practice Address - Street 1:12831 STRATFORD DR APT 190
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-8484
Practice Address - Country:US
Practice Address - Phone:405-371-2293
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-05
Last Update Date:2013-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health