Provider Demographics
NPI:1679926018
Name:KOKO, KOUADIO KRA (RN)
Entity type:Individual
Prefix:MR
First Name:KOUADIO
Middle Name:KRA
Last Name:KOKO
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:13074 PILGRIMS INN DR
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22193-4990
Mailing Address - Country:US
Mailing Address - Phone:703-843-6603
Mailing Address - Fax:571-386-1443
Practice Address - Street 1:13074 PILGRIMS INN DR
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22193-4990
Practice Address - Country:US
Practice Address - Phone:703-843-6603
Practice Address - Fax:571-386-1443
Is Sole Proprietor?:No
Enumeration Date:2016-07-21
Last Update Date:2016-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAHCO-161328163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health