Healthcare Provider Details

I. General information

NPI: 1285247437
Provider Name (Legal Business Name): YONG KO PMHP-BC, NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2020
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3545 LAKE ALFRED RD
WINTER HAVEN FL
33881-1447
US

IV. Provider business mailing address

3545 LAKE ALFRED RD
WINTER HAVEN FL
33881-1447
US

V. Phone/Fax

Practice location:
  • Phone: 863-269-0173
  • Fax: 863-269-0175
Mailing address:
  • Phone: 863-269-0173
  • Fax: 863-269-0175

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN262545
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2020042053
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number0024188769
License Number StateVA
# 4
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN11013363
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: