Provider Demographics
NPI:1255177853
Name:ASAMOAH, JACQUELINE YAA KONADU
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:YAA KONADU
Last Name:ASAMOAH
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 1:1969 AMBERGATE LN APT 4
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38016-3719
Mailing Address - Country:US
Mailing Address - Phone:901-586-7266
Mailing Address - Fax:
Practice Address - Street 1:1969 AMBERGATE LN APT 4
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38016-3719
Practice Address - Country:US
Practice Address - Phone:901-586-7266
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-02
Last Update Date:2025-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant