Healthcare Provider Details

I. General information

NPI: 1609462621
Provider Name (Legal Business Name): PRINCE MENSAH OWUSU DNP-PMHNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2020
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1145 STURGIS ROAD
TWENTYNINE PALMS CA
92278-8275
US

IV. Provider business mailing address

1145 STURGIS ROAD
TWENTYNINE PALMS CA
92278-8275
US

V. Phone/Fax

Practice location:
  • Phone: 760-830-2724
  • Fax:
Mailing address:
  • Phone: 760-830-2724
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number0024187904
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberNONE
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: