Healthcare Provider Details

I. General information

NPI: 1609630797
Provider Name (Legal Business Name): EMMA SELI AFUA HAYFORD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/08/2024
Last Update Date: 02/08/2024
Certification Date: 02/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

141 SCOTT STATION RD
JEFFERSON CITY MO
65109-4975
US

IV. Provider business mailing address

141 SCOTT STATION RD
JEFFERSON CITY MO
65109-4975
US

V. Phone/Fax

Practice location:
  • Phone: 609-481-0124
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number2024003326
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number2024003326
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number2024003326
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: