Provider Demographics
NPI:1306932827
Name:YEBOAH, KORDOR (CRNP)
Entity type:Individual
Prefix:
First Name:KORDOR
Middle Name:
Last Name:YEBOAH
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:838 PENN STREET
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19602
Mailing Address - Country:US
Mailing Address - Phone:610-988-4838
Mailing Address - Fax:610-288-4515
Practice Address - Street 1:838 PENN STREET
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19602
Practice Address - Country:US
Practice Address - Phone:610-988-4838
Practice Address - Fax:610-288-4515
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2012-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP005319B363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102221003Medicaid
PA042444Medicare PIN