Provider Demographics
NPI:1467426254
Name:DAMERON, MARY ANN (FNP-BC PMHNP-BC)
Entity Type:Individual
Prefix:MISS
First Name:MARY
Middle Name:ANN
Last Name:DAMERON
Suffix:
Gender:F
Credentials:FNP-BC PMHNP-BC
Other - Prefix:MRS
Other - First Name:MARY
Other - Middle Name:ANN
Other - Last Name:DAMERON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CRNP, FNP, PMHNP
Mailing Address - Street 1:6810 STONELEDGE CT
Mailing Address - Street 2:
Mailing Address - City:NEW MARKET
Mailing Address - State:MD
Mailing Address - Zip Code:21774-6685
Mailing Address - Country:US
Mailing Address - Phone:336-601-1255
Mailing Address - Fax:
Practice Address - Street 1:365 W PATRICK ST FL 205
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-5093
Practice Address - Country:US
Practice Address - Phone:240-446-0717
Practice Address - Fax:410-202-2107
Is Sole Proprietor?:No
Enumeration Date:2006-02-16
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDAC001349363LF0000X
MDR215473363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
83-00153OtherEVERCARE
NC7003805Medicaid
2632275OtherUNITED HEALTHCARE
83-00153OtherEVERCARE
NC7003805Medicaid