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General NPI Number Information
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NPI Number | 1508072331
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Entity Type | Individual
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Provider Name | KERFALA FOFANA PA-C
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Gender | Male
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Dates
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Enumeration Date | 05/16/2007
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Last Update Date | 08/08/2024
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Provider Practice Location Address
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Address Line | 410 W 10TH AVE
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City | COLUMBUS
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State | OH
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Zip | 43210-1240
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Country | US
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Telephone | 614-293-8305
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Fax | 614-293-3124
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Provider Business Mailing Address
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Address Line | 700 ACKERMAN RD STE 2120
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City | COLUMBUS
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State | OH
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Zip | 43202-1559
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Country | US
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Telephone | 614-293-8000
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 9105531
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 50.007046RX
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License Number State | OH
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