Provider Demographics
NPI:1487465332
Name:AGYARKO, KWABENA ANOKYE
Entity type:Individual
Prefix:
First Name:KWABENA
Middle Name:ANOKYE
Last Name:AGYARKO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24135 ULLAPOOL TER
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:VA
Mailing Address - Zip Code:20166-2775
Mailing Address - Country:US
Mailing Address - Phone:571-992-6803
Mailing Address - Fax:571-500-4826
Practice Address - Street 1:44330 MERCURE CIR STE 162
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:VA
Practice Address - Zip Code:20166-3806
Practice Address - Country:US
Practice Address - Phone:571-992-6803
Practice Address - Fax:571-500-4826
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-17
Last Update Date:2025-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAHCO-0005676251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health