Provider Demographics
NPI:1659975969
Name:ACHEAMPONG, KWAME (NP)
Entity Type:Individual
Prefix:MR
First Name:KWAME
Middle Name:
Last Name:ACHEAMPONG
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 1:1111 STRATFORD AVE APT 404
Mailing Address - Street 2:
Mailing Address - City:STRATFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06615-6380
Mailing Address - Country:US
Mailing Address - Phone:203-278-1125
Mailing Address - Fax:
Practice Address - Street 1:1111 STRATFORD AVE APT 404
Practice Address - Street 2:
Practice Address - City:STRATFORD
Practice Address - State:CT
Practice Address - Zip Code:06615-6380
Practice Address - Country:US
Practice Address - Phone:203-278-1125
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-27
Last Update Date:2021-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR208334163W00000X
CT114524163W00000X
CT9402363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner