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NPI Code Detail

MEDICARE: YONG KO PMH- NP

MEDICARE: YONG KO PMH- NP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163W00000XRegistered NurseRN262545GA
2363LF0000XFamily Nurse Practitioner2020042053GA
3363LP0808XPsychiatric/Mental Health Nurse Practitioner0024188769VA

General Provider Information

NPI Number : 1285247437
Entity Type Code : Individual
Provider Name (Legal Business Name) : YONG KO PMH- NP
Provider Business Mailing Address
First Line : 630 PETER JEFFERSON PKWY STE 130
Second Line :
City : CHARLOTTESVILLE
State : VA
Zip : 22911-4624
Country : US
Telephone Number : 404-844-1244
Fax Number :
Provider Business Practice Location Address
First Line : 630 PETER JEFFERSON PKWY STE 130
Second Line :
City : CHARLOTTESVILLE
State : VA
Zip : 22911-4624
Country : US
Telephone Number : 703-812-4642
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/27/2020
Last Update Date : 05/02/2024

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