Provider Demographics
NPI:1962240796
Name:ANTWI-KISSEADOO, REBECCA (NP)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:ANTWI-KISSEADOO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:BAFFOE
Other - Last Name:ANTWI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:263 PURPLE MARTIN LN
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23435-3329
Mailing Address - Country:US
Mailing Address - Phone:804-497-9795
Mailing Address - Fax:
Practice Address - Street 1:263 PURPLE MARTIN LN
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23435-3329
Practice Address - Country:US
Practice Address - Phone:804-497-9795
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-16
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024190773363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health