Individual provider Active NPI

Kwame Agyen

  • Home Health Registered Nurse
  • Worcester, MA
National Provider Identifier
1124749015
Registry record updated Sep 8, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health Registered NurseTaxonomy code 163WH0200X
License
RN2352031 Issued in MA
Practice address
83 Circuit Ave W
Worcester, MA 01603-2156
Phone
(508) 868-1576
NPI assigned
Sep 8, 2022
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 8, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X RN2352031 MA
Home Health Registered Nurse 163WH0200X RN2352031 MA Primary

Addresses

Primary practice location

83 Circuit Ave W
Worcester, MA 01603-2156

Mailing address

83 Circuit Ave W
Worcester, MA 01603-2156
Phone (508) 868-1576

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
RN2352031MAMDHome Health Registered Nurse

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1662595200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1662595200000",
    "number": "1124749015",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "83 CIRCUIT AVE W",
            "city": "WORCESTER",
            "state": "MA",
            "postal_code": "016032156",
            "telephone_number": "508-868-1576"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "83 CIRCUIT AVE W",
            "city": "WORCESTER",
            "state": "MA",
            "postal_code": "016032156",
            "telephone_number": "508-868-1576"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AGYEN",
        "first_name": "KWAME",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-09-08",
        "last_updated": "2022-09-08",
        "certification_date": "2022-09-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "MA",
            "license": "RN2352031",
            "primary": false
        },
        {
            "code": "163WH0200X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Home Health",
            "state": "MA",
            "license": "RN2352031",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Worcester, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.