Provider Demographics
NPI:1518681402
Name:AGYEPONG, HARRIET (FNP-BC)
Entity Type:Individual
Prefix:
First Name:HARRIET
Middle Name:
Last Name:AGYEPONG
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:HARRIET
Other - Middle Name:
Other - Last Name:AIKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:411 PARKWAY ST STE F
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27401-1644
Mailing Address - Country:US
Mailing Address - Phone:336-543-6769
Mailing Address - Fax:
Practice Address - Street 1:411 PARKWAY ST STE F
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-1644
Practice Address - Country:US
Practice Address - Phone:336-574-0464
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-03
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCAGY-IK083363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily