Provider Demographics
NPI:1609509785
Name:YEBOAH-MENSAH, KOJO (RN)
Entity type:Individual
Prefix:
First Name:KOJO
Middle Name:
Last Name:YEBOAH-MENSAH
Suffix:
Gender:
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12352 COFFEEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MITCHELLS
Mailing Address - State:VA
Mailing Address - Zip Code:22729-2046
Mailing Address - Country:US
Mailing Address - Phone:804-664-0991
Mailing Address - Fax:
Practice Address - Street 1:12352 COFFEEWOOD DR
Practice Address - Street 2:
Practice Address - City:MITCHELLS
Practice Address - State:VA
Practice Address - Zip Code:22729-2046
Practice Address - Country:US
Practice Address - Phone:540-684-0135
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-06
Last Update Date:2025-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001286043163W00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No163W00000XNursing Service ProvidersRegistered Nurse