Provider Demographics
NPI:1922620624
Name:BEDU-ADDO, HAROLD KWEKU
Entity Type:Individual
Prefix:
First Name:HAROLD
Middle Name:KWEKU
Last Name:BEDU-ADDO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5703 GEORGIA LN
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40219-2966
Mailing Address - Country:US
Mailing Address - Phone:614-218-2947
Mailing Address - Fax:
Practice Address - Street 1:220 INTERSTATE PLAZA RD
Practice Address - Street 2:
Practice Address - City:MUNFORDVILLE
Practice Address - State:KY
Practice Address - Zip Code:42765-8400
Practice Address - Country:US
Practice Address - Phone:270-505-9009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-15
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1114681163W00000X
KY3016409363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse