Deidre Opoku, MSN, CNP, PMHNP-BC
Individual provider Active NPI Psychiatric/Mental Health Nurse Practitioner · Reynoldsburg, OH
NPI 1598041287 · NPPES record last updated Jan 1, 2024
Key facts
- NPI
- 1598041287
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychiatric/Mental Health Nurse Practitioner 363LP0808X
- License
- APRN.CNP.0029532 (OH)
- Practice address
- 7664 Slate Ridge Blvd
Reynoldsburg, OH 43068-8158 - Phone
- (614) 710-0173
- Fax
- (614) 987-4032
- NPI assigned
- Oct 26, 2011
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2021
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
7664 Slate Ridge Blvd
Reynoldsburg, OH 43068-8158
Phone (614) 710-0173
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OH
- 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 |
|---|---|---|---|---|
| I20220808000180 | OH | Practitioner - Nurse Practitioner | 9830571850 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Certified Nurse Practitioner, Master of Science - Nursing
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 303997 | OH | MD | Registered Nurse |
| APRN.CNP.0029532 | OH | MD | Psychiatric/Mental Health Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Amazing Grace Mental Wellness Care | Psychiatric/Mental Health | Current |
Accepting new patients |
Locations
7664 Slate Ridge Blvd
Reynoldsburg, OH 43068
Phone (614) 863-4119
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 303997 | OH | |
| Psychiatric/Mental Health Nurse Practitioner | 363LP0808X | APRN.CNP.0029532 | OH | Yes |
Addresses
Primary practice location
7664 Slate Ridge Blvd
Reynoldsburg, OH 43068-8158
Mailing address
7664 Slate Ridge Blvd
Reynoldsburg, OH 43068-8158
Phone (614) 710-0173
Other names
- Deidre Gillespie
Other providers in Reynoldsburg, OH
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- Fartun Hassan Omar
- One Log Home Health Agency Services, Corporation
- Elizabeth Onyango
- Halle Michelle Orlinski
- Alfreda Osei-Mensah
- Wosilat Oshodi
- Tessy Otasowie
- Diane Ouimet
All providers in Reynoldsburg, OH · Psychiatric/Mental Health Nurse Practitioner in Ohio
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 1, 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).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.