Akaninyene Etukudoh, PMHNP is a medicare enrolled "Nurse Practitioner - Psychiatric/mental Health" physician in Phoenix, Arizona. His current practice location is
1095 E Indian School Rd, Phoenix, Arizona. You can reach out to his office (for appointments etc.) via phone at
(623) 439-7645.
Akaninyene Etukudoh is licensed to practice in Arizona (license number 267251) and he also participates in the medicare program. He does not accept medicare assignments directly but he may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. His NPI Number is 1205597887.
Physician's Profile
| Full Name | Akaninyene Etukudoh |
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| Gender | Male |
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| Speciality | Nurse Practitioner - Psychiatric/mental Health |
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| Location | 1095 E Indian School Rd, Phoenix, Arizona |
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| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
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NPI Data:
- NPI Number: 1205597887
- Provider Enumeration Date: 01/05/2022
- Last Update Date: 07/29/2022
Medicare PECOS Information:
- PECOS PAC ID: 9931594397
- Enrollment ID: I20220322000458
Medical Identifiers
Medical identifiers for Akaninyene Etukudoh such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
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| 1205597887 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 2084P0802X | Psychiatry & Neurology - Addiction Psychiatry | 267251 (Arizona) | Secondary |
| 363LP0808X | Nurse Practitioner - Psychiatric/mental Health | 267251 (Arizona) | Primary |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Akaninyene Etukudoh allows following entities to bill medicare on his behalf.
| Entity Name | Psych Zenhealth Pllc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1205302270
PECOS PAC ID: 8921341975
Enrollment ID: O20190515002038 |
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| Entity Name | Freedom Psychiatry Center Llc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1306463070
PECOS PAC ID: 2860806270
Enrollment ID: O20210126003074 |
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| Entity Name | Well Fair Care International |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1053905919
PECOS PAC ID: 4385046465
Enrollment ID: O20210712003628 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Akaninyene Etukudoh is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
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Akaninyene Etukudoh, PMHNP
1095 E Indian School Rd Ste 700,
Phoenix, AZ 85014-4846
Ph: (602) 515-9893 | Akaninyene Etukudoh, PMHNP
1095 E Indian School Rd,
Phoenix, AZ 85014-4801
Ph: (623) 439-7645 |
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