Healthcare Provider Details

I. General information

NPI: 1306518139
Provider Name (Legal Business Name): FELIX ASIEDU KORANTENG PMHNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: FELIX KORANTENG ASIEDU RN

II. Dates (important events)

Enumeration Date: 09/30/2021
Last Update Date: 08/14/2025
Certification Date: 08/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13236 N 7TH ST STE 4
PHOENIX AZ
85022-5343
US

IV. Provider business mailing address

13236 N 7TH ST STE 4 PMB 366
PHOENIX AZ
85022-5343
US

V. Phone/Fax

Practice location:
  • Phone: 602-782-6988
  • Fax: 602-782-6989
Mailing address:
  • Phone: 602-782-6988
  • Fax: 602-782-6989

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number222736
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number222736
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: