Provider Demographics
NPI:1184334997
Name:AMOA OHENAKWAH, KATE
Entity type:Individual
Prefix:
First Name:KATE
Middle Name:
Last Name:AMOA OHENAKWAH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 SAINT GEORGES AVE APT 102
Mailing Address - Street 2:
Mailing Address - City:AVENEL
Mailing Address - State:NJ
Mailing Address - Zip Code:07001-1186
Mailing Address - Country:US
Mailing Address - Phone:516-451-2253
Mailing Address - Fax:
Practice Address - Street 1:655 E JERSEY ST
Practice Address - Street 2:
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07206-1259
Practice Address - Country:US
Practice Address - Phone:908-994-7552
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-02
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF404328363LP0808X
NJ26NJ01478600363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health