Provider Demographics
NPI:1508296542
Name:AGYEKUM, KARREN
Entity type:Individual
Prefix:
First Name:KARREN
Middle Name:
Last Name:AGYEKUM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 E HIGH ST
Mailing Address - Street 2:
Mailing Address - City:EAST HAMPTON
Mailing Address - State:CT
Mailing Address - Zip Code:06424-1052
Mailing Address - Country:US
Mailing Address - Phone:866-389-2727
Mailing Address - Fax:480-718-7643
Practice Address - Street 1:54 E HIGH ST
Practice Address - Street 2:
Practice Address - City:EAST HAMPTON
Practice Address - State:CT
Practice Address - Zip Code:06424-1052
Practice Address - Country:US
Practice Address - Phone:866-389-2727
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-12
Last Update Date:2025-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF347534-01207Q00000X
GARN311269207Q00000X
CT5531363LF0000X
PASP026123207Q00000X
VA0024183929207Q00000X
SC26025207Q00000X
SDCP002376207Q00000X
NC5016238207Q00000X
WV112485207Q00000X
NJ26NJ14927800207Q00000X
WI13283-33207Q00000X
NDR52162207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine