Healthcare Provider Details

I. General information

NPI: 1639860182
Provider Name (Legal Business Name): GRACE KAKIE AWO AIDOO PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. GRACE OCANSEY

II. Dates (important events)

Enumeration Date: 05/16/2023
Last Update Date: 02/16/2026
Certification Date: 02/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8693 BRENSTUHL PARK DR
BLACKLICK OH
43004-8828
US

IV. Provider business mailing address

8693 BRENSTUHL PARK DR
BLACKLICK OH
43004-8828
US

V. Phone/Fax

Practice location:
  • Phone: 614-989-6019
  • Fax: 614-321-1788
Mailing address:
  • Phone: 614-989-6019
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number0040680
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number499910
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: