Kehinde M Ajikobi
Individual provider Active NPI Registered Nurse · Medford, NY
NPI 1659976389 · NPPES record last updated Apr 18, 2024
Key facts
- NPI
- 1659976389
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Registered Nurse 163W00000X
- License
- 815345-01 (NY)
- Practice address
- 2302 Fire Ave
Medford, NY 11763-1714 - Phone
- (631) 816-9044
- NPI assigned
- Dec 1, 2020
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 815345-01 | NY | MD | Registered Nurse |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Licensed Practical Nurse | 164W00000X | 336791 | NY | |
| Registered Nurse | 163W00000X | 815345-01 | NY | Yes |
Addresses
Primary practice location
2302 Fire Ave
Medford, NY 11763-1714
Mailing address
2302 Fire Ave
Medford, NY 11763-1714
Phone (631) 816-9044
Other providers in Medford, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 18, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.