Individual provider Active NPI

Rebecca Frempong Antwi

  • Psychiatric/Mental Health Nurse Practitioner
  • Pawtucket, RI
National Provider Identifier
1396328357
Registry record updated Oct 23, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
APRN02905 Issued in RI
Practice address
120 Armistice Blvd Ste 1
Pawtucket, RI 02860-3208
Phone
(508) 762-7344
NPI assigned
Apr 28, 2021
Last updated
Oct 23, 2024By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 23, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 1051009 TX
Psychiatric/Mental Health Nurse Practitioner 363LP0808X RN2275333 MA
Psychiatric/Mental Health Nurse Practitioner 363LP0808X APRN02905 RI Primary

Addresses

Primary practice location

120 Armistice Blvd Ste 1
Pawtucket, RI 02860-3208

Mailing address

110 Armistice Blvd Ste 1
Pawtucket, RI 02860-5354

Other practice location 1

16903 Red Oak Dr
Houston, TX 77090-3914
Phone (617) 315-8835

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in RI, MA, TX3 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
I20241120001508 RI Practitioner - Nurse Practitioner 2062947633 Reassigns benefits to 1 organization
I20241120001781 MA Practitioner - Nurse Practitioner 2062947633 Reassigns benefits to 1 organization
I20250204002931 TX Practitioner - Nurse Practitioner 2062947633 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
APRN02905RIMDPsychiatric/Mental Health Nurse Practitioner
1051009TXMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Bright Star Behavioral, LLC Psychiatric/Mental Health CurrentSince Oct 16, 2024 Accepting new patients
Mmtherapy&Consulting LLC PastSince Oct 30, 2024 Accepting new patients

Locations

110 Armistice Blvd
Ste 1
Pawtucket, RI 02860

12254 Queenston Blvd
Ste E
Houston, TX 77095
Phone (832) 213-8912

16903 Red Oak Dr
Ste 130F
Houston, TX 77090
Phone (401) 216-7372

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1619568000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1729641600000",
    "number": "1396328357",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 ARMISTICE BLVD STE 1",
            "city": "PAWTUCKET",
            "state": "RI",
            "postal_code": "028605354"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 ARMISTICE BLVD STE 1",
            "city": "PAWTUCKET",
            "state": "RI",
            "postal_code": "028603208",
            "telephone_number": "508-762-7344"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "16903 Red Oak Dr",
            "address_purpose": "LOCATION",
            "city": "Houston",
            "state": "TX",
            "postal_code": "770903914",
            "country_code": "US",
            "telephone_number": "617-315-8835",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ANTWI",
        "first_name": "REBECCA",
        "middle_name": "FREMPONG",
        "name_prefix": "Mrs.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-04-28",
        "last_updated": "2024-10-23",
        "certification_date": "2024-10-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "TX",
            "license": "1051009",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "MA",
            "license": "RN2275333",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "RI",
            "license": "APRN02905",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pawtucket, RI

Sources for this page

Verify at the official NPI Registry.