Provider Demographics
NPI:1215303946
Name:KWAKUYI, JOY (APRN)
Entity type:Individual
Prefix:
First Name:JOY
Middle Name:
Last Name:KWAKUYI
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4400 E BROADWAY BLVD STE 411
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85711-3554
Mailing Address - Country:US
Mailing Address - Phone:520-505-7184
Mailing Address - Fax:520-595-5016
Practice Address - Street 1:4400 E BROADWAY BLVD STE 411
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711-3554
Practice Address - Country:US
Practice Address - Phone:520-505-7184
Practice Address - Fax:520-595-5016
Is Sole Proprietor?:No
Enumeration Date:2015-08-17
Last Update Date:2020-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP8098363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health