Healthcare Provider Details

I. General information

NPI: 1417749987
Provider Name (Legal Business Name): EVELYN AFRIYIE YEBOAH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2025
Last Update Date: 09/26/2025
Certification Date: 09/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4706 BROAD FALLS LN
KNIGHTDALE NC
27545-5131
US

IV. Provider business mailing address

4706 BROAD FALLS LN
KNIGHTDALE NC
27545-5131
US

V. Phone/Fax

Practice location:
  • Phone: 919-931-9080
  • Fax:
Mailing address:
  • Phone: 919-931-9080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number5022400
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: