Healthcare Provider Details

I. General information

NPI: 1124918743
Provider Name (Legal Business Name): BENETTE Y. AKPOR
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2025
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5123 IRONSIDES DR
FREDERICK MD
21703-7396
US

IV. Provider business mailing address

5123 IRONSIDES DR
FREDERICK MD
21703-7396
US

V. Phone/Fax

Practice location:
  • Phone: 240-314-9869
  • Fax: 240-314-9869
Mailing address:
  • Phone: 240-314-9869
  • Fax: 240-314-9869

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR200408
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberR200408
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: