Provider Demographics
NPI:1194722256
Name:EKMAN, JOHN KEVIN (FNP- C, PMHNP)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:KEVIN
Last Name:EKMAN
Suffix:
Gender:M
Credentials:FNP- C, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 23RD ST.
Mailing Address - Street 2:
Mailing Address - City:SAFFORD
Mailing Address - State:AZ
Mailing Address - Zip Code:85546
Mailing Address - Country:US
Mailing Address - Phone:928-348-9602
Mailing Address - Fax:928-428-7266
Practice Address - Street 1:624 W 8TH ST
Practice Address - Street 2:
Practice Address - City:SAFFORD
Practice Address - State:AZ
Practice Address - Zip Code:85546-2807
Practice Address - Country:US
Practice Address - Phone:928-428-6554
Practice Address - Fax:928-428-7266
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-05
Last Update Date:2008-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP1902363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ859655Medicaid
AZ859655Medicaid