Healthcare Provider Details

I. General information

NPI: 1598462939
Provider Name (Legal Business Name): FIDELITY AGEH AKONJI NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: FIDELITY AKONJI NP

II. Dates (important events)

Enumeration Date: 02/15/2023
Last Update Date: 02/15/2023
Certification Date: 02/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1778 E. STATE ROAD 44
SHELBYVILLE IN
46176-1846
US

IV. Provider business mailing address

PO BOX 306417
NASHVILLE TN
37230-6417
US

V. Phone/Fax

Practice location:
  • Phone: 463-235-3043
  • Fax:
Mailing address:
  • Phone: 931-253-1110
  • Fax: 931-722-9919

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number71073550A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: