Healthcare Provider Details

I. General information

NPI: 1619777562
Provider Name (Legal Business Name): BAFFOUR KOFI GYAMFI DNP - PMHNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: KOFI GYAMFI KOFI

II. Dates (important events)

Enumeration Date: 03/18/2025
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5553 W WATERFORD LN STE A
APPLETON WI
54913-8468
US

IV. Provider business mailing address

5553 W WATERFORD LN STE A
APPLETON WI
54913-8468
US

V. Phone/Fax

Practice location:
  • Phone: 920-427-9315
  • Fax: 920-423-9055
Mailing address:
  • Phone: 920-427-9315
  • Fax: 920-423-9055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number16623-33
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: