Provider Demographics
NPI:1235621160
Name:OPOKU, AGNES (NP)
Entity Type:Individual
Prefix:
First Name:AGNES
Middle Name:
Last Name:OPOKU
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3293 KENT DR
Mailing Address - Street 2:
Mailing Address - City:BROWNSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:46112-5803
Mailing Address - Country:US
Mailing Address - Phone:317-549-8959
Mailing Address - Fax:
Practice Address - Street 1:1201 N POST RD STE 4
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46219-4225
Practice Address - Country:US
Practice Address - Phone:317-405-8833
Practice Address - Fax:317-672-2398
Is Sole Proprietor?:No
Enumeration Date:2018-06-06
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INF02180983363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300038692Medicaid