Healthcare Provider Details

I. General information

NPI: 1750208278
Provider Name (Legal Business Name): KOKOU AKPO-GNANDI APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/06/2026
Certification Date: 07/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21926 AVALON QUEEN DR
SPRING TX
77379-5922
US

IV. Provider business mailing address

21926 AVALON QUEEN DR
SPRING TX
77379-5922
US

V. Phone/Fax

Practice location:
  • Phone: 402-714-4484
  • Fax:
Mailing address:
  • Phone: 402-714-4484
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number1242021
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number1242021
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number1242021
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: