Healthcare Provider Details

I. General information

NPI: 1629100490
Provider Name (Legal Business Name): KENNETH K. K AKABUTU LPN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3898 FARMBROOK LN
COLUMBUS OH
43204-1572
US

IV. Provider business mailing address

3898 FARMBROOK LN
COLUMBUS OH
43204-1572
US

V. Phone/Fax

Practice location:
  • Phone: 614-275-2072
  • Fax:
Mailing address:
  • Phone: 614-275-2072
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License NumberPN121801
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: