Healthcare Provider Details

I. General information

NPI: 1407203482
Provider Name (Legal Business Name): AKWASI AGYEMANG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2016
Last Update Date: 08/07/2023
Certification Date: 08/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 N HIGH ST
COLUMBUS OH
43201-2460
US

IV. Provider business mailing address

1301 N HIGH ST
COLUMBUS OH
43201-2460
US

V. Phone/Fax

Practice location:
  • Phone: 614-299-6600
  • Fax: 614-421-3111
Mailing address:
  • Phone: 614-299-6600
  • Fax: 614-421-3111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License NumberMA4767680
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License NumberRN.397389-
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License NumberAPRN.CNP.022658
License Number StateOH
# 4
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.022658
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: