Healthcare Provider Details

I. General information

NPI: 1831406222
Provider Name (Legal Business Name): AICHA EVELYNE KAKOU FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2010
Last Update Date: 01/13/2025
Certification Date: 01/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5650 S 12TH AVE STE 132
TUCSON AZ
85706-3187
US

IV. Provider business mailing address

234 N CENTRAL AVE # AZ85004
PHOENIX AZ
85004-2208
US

V. Phone/Fax

Practice location:
  • Phone: 877-465-6650
  • Fax: 804-294-2775
Mailing address:
  • Phone: 608-481-6389
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number277245
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: