=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235951153
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | EVANS AGYEMANG DUAH PMHNP
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/30/2024
-----------------------------------------------------
Last Update Date | 03/14/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 63 EDDIE DOWLING HWY STE 8
-----------------------------------------------------
City | NORTH SMITHFIELD
-----------------------------------------------------
State | RI
-----------------------------------------------------
Zip | 02896-7322
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 781-666-2711
-----------------------------------------------------
Fax | 781-666-2712
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 67 UNION ST STE 106
-----------------------------------------------------
City | NATICK
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01760-7700
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 781-666-2711
-----------------------------------------------------
Fax | 781-666-2712
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number | RN2333831
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number | RN80447
-----------------------------------------------------
License Number State | RI
-----------------------------------------------------