Healthcare Provider Details

I. General information

NPI: 1972465623
Provider Name (Legal Business Name): EDWARD AMOAH ACHEAMPONG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2025
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

745 E 8TH ST
WINNER SD
57580-2677
US

IV. Provider business mailing address

745 E 8TH ST
WINNER SD
57580-2677
US

V. Phone/Fax

Practice location:
  • Phone: 605-842-7100
  • Fax:
Mailing address:
  • Phone: 605-842-7100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberCP003943
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: