Provider Demographics
NPI:1598041287
Name:OPOKU, DEIDRE (MSN, CNP, PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:DEIDRE
Middle Name:
Last Name:OPOKU
Suffix:
Gender:F
Credentials:MSN, CNP, PMHNP-BC
Other - Prefix:
Other - First Name:DEIDRE
Other - Middle Name:
Other - Last Name:GILLESPIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSN, RN
Mailing Address - Street 1:7664 SLATE RIDGE BLVD
Mailing Address - Street 2:
Mailing Address - City:REYNOLDSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43068-8158
Mailing Address - Country:US
Mailing Address - Phone:614-710-0173
Mailing Address - Fax:614-987-4032
Practice Address - Street 1:7664 SLATE RIDGE BLVD
Practice Address - Street 2:
Practice Address - City:REYNOLDSBURG
Practice Address - State:OH
Practice Address - Zip Code:43068-8158
Practice Address - Country:US
Practice Address - Phone:614-710-0173
Practice Address - Fax:614-987-4032
Is Sole Proprietor?:No
Enumeration Date:2011-10-26
Last Update Date:2024-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH303997163W00000X, 163WH0200X, 163WP0200X, 374U00000X, 376K00000X
OHAPRN.CNP.0029532363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163WP0200XNursing Service ProvidersRegistered NursePediatrics
No374U00000XNursing Service Related ProvidersHome Health Aide
No376K00000XNursing Service Related ProvidersNurse's Aide