Healthcare Provider Details

I. General information

NPI: 1649020850
Provider Name (Legal Business Name): KOKOUVI HIHEGLO CRNP-PMH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2024
Last Update Date: 05/22/2024
Certification Date: 05/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6701 DEMOCRACY BLVD STE 300
BETHESDA MD
20817-7500
US

IV. Provider business mailing address

7661 ARUNDEL MILLS BLVD
HANOVER MD
21076-1305
US

V. Phone/Fax

Practice location:
  • Phone: 646-941-7645
  • Fax:
Mailing address:
  • Phone: 667-225-0673
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR239579
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number787140
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number787140
License Number StateMD
# 4
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number787140
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: