Individual provider Active NPI

Nickesha Marie Brown-Fokuo, APRN

  • Family Nurse Practitioner
  • West Haven, CT
National Provider Identifier
1336900331
Registry record updated Mar 7, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
12796 Issued in CT
Practice address
755 Campbell Ave
West Haven, CT 06516-3789
Phone
(203) 937-1100
NPI assigned
Jan 17, 2024
Last updated
Mar 7, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 12796 CT Primary
Nurse Practitioner 363L00000X 12796 CT

Addresses

Primary practice location

755 Campbell Ave
West Haven, CT 06516-3789

Mailing address

755 Campbell Ave
West Haven, CT 06516-3789
Phone (203) 937-1100

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240319001329 CT Practitioner - Nurse Practitioner 5991142515 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2023
Medicare assignment
May accept Medicare assignment
Telehealth
Offers telehealth services
Group practices
Campbell Medical Services LLCGroup PAC ID 2163586454, 12 clinicians

Practice addresses (Care Compare)

755 Campbell Ave
Suite 1
West Haven, CT 06516-3789
Phone (203) 937-1100

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
12796CTMDPeriodontist

Practice roles

OrganizationSpecialtyStatusNew patients
Campbell Medical Services, LLC Family CurrentSince Feb 19, 2024 Accepting new patients

Locations

755 Campbell Ave
West Haven, CT 06516
Phone (203) 882-9608

755 Campbell Ave
Ste 1
West Haven, CT 06516
Phone (203) 937-1100

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1705449600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1709769600000",
    "number": "1336900331",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "755 CAMPBELL AVE",
            "city": "WEST HAVEN",
            "state": "CT",
            "postal_code": "065163789",
            "telephone_number": "203-937-1100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "755 CAMPBELL AVE",
            "city": "WEST HAVEN",
            "state": "CT",
            "postal_code": "065163789",
            "telephone_number": "203-937-1100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROWN-FOKUO",
        "first_name": "NICKESHA",
        "middle_name": "MARIE",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-01-17",
        "last_updated": "2024-03-07",
        "certification_date": "2024-02-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CT",
            "license": "12796",
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "CT",
            "license": "12796",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in West Haven, CT

Sources for this page

Verify at the official NPI Registry.