Amazing Grace Mental Wellness Care
Organization Active NPI Psychiatric/Mental Health Nurse Practitioner · Reynoldsburg, OH
NPI 1972236636 · NPPES record last updated Jul 8, 2022
Key facts
- NPI
- 1972236636
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Psychiatric/Mental Health Nurse Practitioner 363LP0808X
- Legal business name
- AMAZING GRACE MENTAL WELLNESS CARE
- Practice address
- 7664 Slate Ridge Blvd
Reynoldsburg, OH 43068-8158 - Phone
- (614) 710-0173
- Fax
- (614) 987-4032
- NPI assigned
- Jul 8, 2022
- Organization subpart
- No
Authorized official
- Name
- Deidre Opoku, APRN-CNP, PMHNP-BC
- Title
- Owner/Psychiatric NP
- Phone
- (614) 710-0173
Practitioners 1
-
Deidre Opoku, MSN, CNP, PMHNP-BC
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OH
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20220808000144 | OH | Part B Supplier - Clinic/Group Practice | 8921480948 |
Receives reassigned benefits from 1 practitioner Practice locations: Reynoldsburg, OH |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatric/Mental Health Nurse Practitioner |
363LP0808X | 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 providers in Reynoldsburg, OH
- Alpha & Omega Supported Living Agency, LLC
- Isobel Alsup
- Esther Winifred Aluko
- Grace Oluchi Amakulor
- Amandacare, Inc.
- Ambassador Home Health Services, LLC
- Ililli Ambi
- Comfort Doeyo Amenyah
- Alexandra Alyssa Anderson
- Ashley Anderson
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 Jul 8, 2022. 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.