Healthcare Provider Details

I. General information

NPI: 1285597617
Provider Name (Legal Business Name): INIOBONG KOFFI PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/03/2025
Last Update Date: 02/03/2026
Certification Date: 02/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6232 N 7TH ST STE 101
PHOENIX AZ
85014-1850
US

IV. Provider business mailing address

6232 N 7TH ST STE 101
PHOENIX AZ
85014-1850
US

V. Phone/Fax

Practice location:
  • Phone: 623-233-0914
  • Fax: 623-321-6050
Mailing address:
  • Phone: 623-233-0914
  • Fax: 623-321-6050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License Number265764
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number265764
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: