Provider Demographics
NPI:1548082068
Name:AGYEKUM, AMA DUFIE
Entity type:Individual
Prefix:
First Name:AMA
Middle Name:DUFIE
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 1:7671 LYNN CREEK DR
Mailing Address - Street 2:
Mailing Address - City:NORTH PRINCE GEORGE
Mailing Address - State:VA
Mailing Address - Zip Code:23860-7018
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4720 PUDDLEDOCK RD
Practice Address - Street 2:
Practice Address - City:PRINCE GEORGE
Practice Address - State:VA
Practice Address - Zip Code:23875-1275
Practice Address - Country:US
Practice Address - Phone:804-452-4546
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-28
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024191438363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily