Provider Demographics
NPI:1619631215
Name:YEBOAH, OBIRI (APRN AGNP-C)
Entity Type:Individual
Prefix:MR
First Name:OBIRI
Middle Name:
Last Name:YEBOAH
Suffix:
Gender:M
Credentials:APRN AGNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6633
Mailing Address - Street 2:
Mailing Address - City:BROOKINGS
Mailing Address - State:OR
Mailing Address - Zip Code:97415-0288
Mailing Address - Country:US
Mailing Address - Phone:707-954-6068
Mailing Address - Fax:
Practice Address - Street 1:17153 PARKVIEW DR # 6633
Practice Address - Street 2:
Practice Address - City:BROOKINGS
Practice Address - State:OR
Practice Address - Zip Code:97415-9710
Practice Address - Country:US
Practice Address - Phone:707-954-6068
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-29
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR202110590NP-PP363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care