Provider Demographics
NPI:1972387991
Name:MEKOH, MAGDALEN K (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:MAGDALEN
Middle Name:K
Last Name:MEKOH
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:MISS
Other - First Name:MAGDALEN
Other - Middle Name:KIEN
Other - Last Name:ZAMA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9850 VON ALLMEN CT STE 201
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40241-2855
Mailing Address - Country:US
Mailing Address - Phone:859-705-7770
Mailing Address - Fax:
Practice Address - Street 1:9850 VON ALLMEN CT STE 201
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40241-2855
Practice Address - Country:US
Practice Address - Phone:
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-21
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4008073363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health