MEDICARE: KINGSLEY EYONG ENOW 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
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	0031826	OH

General Provider Information

NPI Number	:	1477815892
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KINGSLEY EYONG ENOW NP

Provider Business Mailing Address
First Line	:	3505 E LIVINGSTON AVE STE G
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43227-2252
Country	:	US
Telephone Number	:	614-715-8216
Fax Number	:	614-715-8239

Provider Business Practice Location Address
First Line	:	3505 E LIVINGSTON AVE STE G
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43227-2252
Country	:	US
Telephone Number	:	614-632-1018
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/12/2012
Last Update Date	:	11/17/2023

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