Provider Demographics
NPI:1508626367
Name:OWUSU-ADADE, AUGUSTINE KOJO (NP)
Entity Type:Individual
Prefix:
First Name:AUGUSTINE
Middle Name:KOJO
Last Name:OWUSU-ADADE
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2802 KINGLY PINE TRL
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77385-2049
Mailing Address - Country:US
Mailing Address - Phone:267-567-4707
Mailing Address - Fax:
Practice Address - Street 1:2802 KINGLY PINE TRL
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77385-2049
Practice Address - Country:US
Practice Address - Phone:267-567-4707
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-20
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1016786363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care