Provider Demographics
NPI:1124854260
Name:AMISSAH, GLORIA (APRN-PMHNP)
Entity type:Individual
Prefix:
First Name:GLORIA
Middle Name:
Last Name:AMISSAH
Suffix:
Gender:F
Credentials:APRN-PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3664 REVOLUTIONARY DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43207-6535
Mailing Address - Country:US
Mailing Address - Phone:614-805-8313
Mailing Address - Fax:
Practice Address - Street 1:3664 REVOLUTIONARY DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43207-6535
Practice Address - Country:US
Practice Address - Phone:614-805-8313
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-13
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0037536363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health