Fosua Agyenim Boateng, PMHNP
Individual provider Active NPI Psychiatric/Mental Health Nurse Practitioner · Mount Vernon, NY
NPI 1013772128 · NPPES record last updated Feb 19, 2024
Key facts
- NPI
- 1013772128
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychiatric/Mental Health Nurse Practitioner 363LP0808X
- License
- 405667 (NY)
- Practice address
- 6 Gramatan Ave Ste 606
Mount Vernon, NY 10550-3208 - Phone
- (212) 961-7299
- NPI assigned
- Feb 19, 2024
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NY
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20241003002582 | NY | Practitioner - Nurse Practitioner | 6002347887 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 405667 | NY | MD | Psychiatric/Mental Health Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Tri-Star Behavioral Health Inc | Psychiatric/Mental Health | Current |
Accepting new patients |
Locations
6 Gramatan Ave
Ste 606
Mount Vernon, NY 10550
Phone (201) 580-6642
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatric/Mental Health Nurse Practitioner | 363LP0808X | 405667 | NY | Yes |
Addresses
Primary practice location
6 Gramatan Ave Ste 606
Mount Vernon, NY 10550-3208
Mailing address
207 Hoover Rd Apt 2
Yonkers, NY 10710-3440
Phone (914) 536-7623
Other providers in Mount Vernon, NY
- Francis O. Agbonkpolo
- Guirlaine Lenore Agnant
- Ana Aguilar
- Gifty Agyemang
- Victoria Agyemang
- Nabeela Ahmed
- Sangeeta Ahuja
- Gladys E Aideyan
- Paula Aikens-Bennett
- Mir Akbar
All providers in Mount Vernon, NY · Psychiatric/Mental Health Nurse Practitioner in New York
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 19, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.