Provider Demographics
NPI:1104962257
Name:OWUSU, AKUA (MD)
Entity type:Individual
Prefix:
First Name:AKUA
Middle Name:
Last Name:OWUSU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2394 FOXHAVEN DR W
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32224-2010
Mailing Address - Country:US
Mailing Address - Phone:904-887-3382
Mailing Address - Fax:
Practice Address - Street 1:2055 REYKO RD STE 100
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-2828
Practice Address - Country:US
Practice Address - Phone:239-690-6906
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME676052084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL104250OtherUNITED BEHAVIORAL HEALTH
FL378045700Medicaid
FL27808OtherBLUE CROSS & BLUE SHIELD
FL27808Medicare PIN
FLF82219Medicare UPIN
FL104250OtherUNITED BEHAVIORAL HEALTH