Healthcare Provider Details

I. General information

NPI: 1821966037
Provider Name (Legal Business Name): NKONGLAK FORKU FELIX
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/28/2025
Last Update Date: 01/06/2026
Certification Date: 01/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6323 64TH AVE APT 5
RIVERDALE MD
20737-1517
US

IV. Provider business mailing address

6323 64TH AVE APT 5
RIVERDALE MD
20737-1517
US

V. Phone/Fax

Practice location:
  • Phone: 240-380-6964
  • Fax:
Mailing address:
  • Phone: 240-380-6964
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: