MEDICARE: GLORIA AMISSAH APRN-PMHNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	0037536	OH

General Provider Information

NPI Number	:	1124854260
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GLORIA AMISSAH APRN-PMHNP

Provider Business Mailing Address
First Line	:	665 E DUBLIN GRANVILLE RD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43229-3245
Country	:	US
Telephone Number	:	614-805-8313
Fax Number	:

Provider Business Practice Location Address
First Line	:	3664 REVOLUTIONARY DR
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43207-6535
Country	:	US
Telephone Number	:	614-805-8313
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/13/2024
Last Update Date	:	07/28/2025

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