Provider Demographics
NPI:1871959965
Name:AYIYI, OSAGINWEN KINGSLEY (NP-C)
Entity type:Individual
Prefix:
First Name:OSAGINWEN
Middle Name:KINGSLEY
Last Name:AYIYI
Suffix:
Gender:M
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3301 E THOMAS RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-7302
Mailing Address - Country:US
Mailing Address - Phone:602-899-7774
Mailing Address - Fax:602-899-7877
Practice Address - Street 1:3301 E THOMAS RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-7302
Practice Address - Country:US
Practice Address - Phone:602-899-7774
Practice Address - Fax:602-899-7877
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-06
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP8375363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ230287Medicaid