Provider Demographics
NPI:1700169117
Name:KPOGLI, KOMI (RN)
Entity type:Individual
Prefix:
First Name:KOMI
Middle Name:
Last Name:KPOGLI
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 URICH DR
Mailing Address - Street 2:
Mailing Address - City:PICKERINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43147-7833
Mailing Address - Country:US
Mailing Address - Phone:859-457-0032
Mailing Address - Fax:
Practice Address - Street 1:124 URICH DR
Practice Address - Street 2:
Practice Address - City:PICKERINGTON
Practice Address - State:OH
Practice Address - Zip Code:43147-7833
Practice Address - Country:US
Practice Address - Phone:859-457-0032
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-21
Last Update Date:2017-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH316816163W00000X
OHAPRN.CNS.019314364SG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SG0600XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistGerontology
No163W00000XNursing Service ProvidersRegistered Nurse