Healthcare Provider Details

I. General information

NPI: 1164717492
Provider Name (Legal Business Name): PRISCILLA NANA AMA OWUSU M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2011
Last Update Date: 03/12/2025
Certification Date: 03/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 TERRA CROSSING BLVD STE 402
LOUISVILLE KY
40245-5395
US

IV. Provider business mailing address

PO BOX 909
LOUISVILLE KY
40201-0909
US

V. Phone/Fax

Practice location:
  • Phone: 502-210-4530
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number46878
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: