Provider Demographics
NPI:1578302725
Name:ARDOIN, AKILA SADE
Entity type:Individual
Prefix:
First Name:AKILA
Middle Name:SADE
Last Name:ARDOIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2688 CALDER ST
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77702-1917
Mailing Address - Country:US
Mailing Address - Phone:409-813-2206
Mailing Address - Fax:409-813-2236
Practice Address - Street 1:2688 CALDER ST
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77702-1917
Practice Address - Country:US
Practice Address - Phone:409-813-2206
Practice Address - Fax:409-813-2236
Is Sole Proprietor?:No
Enumeration Date:2024-05-20
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX350791164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse