Healthcare Provider Details

I. General information

NPI: 1679344212
Provider Name (Legal Business Name): KAKRA GYMFUAA AGYEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2024
Last Update Date: 01/23/2025
Certification Date: 01/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3009 BURNET AVE
CINCINNATI OH
45219
US

IV. Provider business mailing address

601 E PETE ROSE WAY
CINCINNATI OH
45202
US

V. Phone/Fax

Practice location:
  • Phone: 513-872-8880
  • Fax:
Mailing address:
  • Phone: 407-782-3139
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN.CNP.0037715
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License NumberRN.481673
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: