Provider Demographics
NPI:1700699584
Name:AWA, KINGSLEY PENN
Entity type:Individual
Prefix:MR
First Name:KINGSLEY
Middle Name:PENN
Last Name:AWA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3718 COOPER LN
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20784-2425
Mailing Address - Country:US
Mailing Address - Phone:202-280-0622
Mailing Address - Fax:
Practice Address - Street 1:3718 COOPER LN
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20784-2425
Practice Address - Country:US
Practice Address - Phone:202-280-0622
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-27
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No171M00000XOther Service ProvidersCase Manager/Care Coordinator