Healthcare Provider Details

I. General information

NPI: 1427944198
Provider Name (Legal Business Name): EVELYN ASAMOAH ADDO OWUSU-KYEREKO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: EVELYN ASAMOAH ADDO

II. Dates (important events)

Enumeration Date: 06/17/2025
Last Update Date: 06/17/2025
Certification Date: 06/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5223 BUTTERCUP DR
TIPP CITY OH
45371-8461
US

IV. Provider business mailing address

5223 BUTTERCUP DR
TIPP CITY OH
45371-8461
US

V. Phone/Fax

Practice location:
  • Phone: 209-221-3723
  • Fax:
Mailing address:
  • Phone: 209-221-3723
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number1094403
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: