Healthcare Provider Details

I. General information

NPI: 1245722636
Provider Name (Legal Business Name): BARBARA AGYEMAN-PREMPEH FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2018
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 SHUMARD OAK DR
WOODBRIDGE VA
22191-7536
US

IV. Provider business mailing address

2900 SHUMARD OAK DR
WOODBRIDGE VA
22191-7536
US

V. Phone/Fax

Practice location:
  • Phone: 571-562-5669
  • Fax:
Mailing address:
  • Phone: 571-563-5669
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number0024197259
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: