Provider Demographics
NPI:1043522659
Name:UWEH, KETTY UKPONG (NP)
Entity type:Individual
Prefix:MRS
First Name:KETTY
Middle Name:UKPONG
Last Name:UWEH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1552 COFFEE RD STE 200
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355-3122
Mailing Address - Country:US
Mailing Address - Phone:209-248-7168
Mailing Address - Fax:209-846-9641
Practice Address - Street 1:644 E HARDING WAY STE B
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95204-6103
Practice Address - Country:US
Practice Address - Phone:209-244-9191
Practice Address - Fax:209-244-9190
Is Sole Proprietor?:No
Enumeration Date:2010-07-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18699363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily