Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | ||
N | 207P00000X | Emergency Physician | 40708 | TN |
N | 207R00000X | Internist | 0101242839 | VA |
N | 111NI0900X | Internist | 0101242839 | VA |
Y | 207R00000X | Internist | 29872 | WV |
Y | 111NI0900X | Internist | 29872 | WV |
N | 207R00000X | Internist | 40708 | TN |
N | 111NI0900X | Internist | 40708 | TN |
N | 207RA0401X | Internist - Addiction Medicine | FO3926663 | TN |
NPI | 1881668937 |
---|---|
Provider Name | Yaw Otchere-Boateng |
First Address | Kingsport, TN 37660-5694 |
Second Address | Charleston, WV 25311-2124 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/02/2006 |
Last Update Date | 25/02/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I47997 | (02) | TN |