Healthcare Provider Details

I. General information

NPI: 1619705977
Provider Name (Legal Business Name): DR. KWAME ACHEAMPONG
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2024
Last Update Date: 08/01/2024
Certification Date: 08/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 HARVESTER DR
COPLEY OH
44321-1001
US

IV. Provider business mailing address

20 HARVESTER DR
COPLEY OH
44321-1001
US

V. Phone/Fax

Practice location:
  • Phone: 701-260-9004
  • Fax:
Mailing address:
  • Phone: 701-260-9004
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.0037212
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: