Provider Demographics
NPI:1245988484
Name:ANTWI, AGYARE (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:AGYARE
Middle Name:
Last Name:ANTWI
Suffix:
Gender:M
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17339 HEATH GROVE LN
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77407-8027
Mailing Address - Country:US
Mailing Address - Phone:574-217-2408
Mailing Address - Fax:
Practice Address - Street 1:17339 HEATH GROVE LN
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77407-8027
Practice Address - Country:US
Practice Address - Phone:574-217-2408
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-16
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR202205300RN163W00000X
TX1068282363LP0808X
OR202205309NP-PP363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
15535934OtherCAQH ID
OR500810911Medicaid