Provider Demographics
NPI:1356989339
Name:ACHEAMPONG, GIFTY (PMHNP)
Entity type:Individual
Prefix:
First Name:GIFTY
Middle Name:
Last Name:ACHEAMPONG
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1714 10TH ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76301-5011
Mailing Address - Country:US
Mailing Address - Phone:940-766-4482
Mailing Address - Fax:940-766-4487
Practice Address - Street 1:1714 10TH ST
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76301-5011
Practice Address - Country:US
Practice Address - Phone:940-766-4482
Practice Address - Fax:940-766-4482
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-20
Last Update Date:2020-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX04044908363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health