Provider Demographics
NPI:1508237512
Name:CALLAHAN, CHRISTY (PMHNP-BC, CRNP)
Entity Type:Individual
Prefix:
First Name:CHRISTY
Middle Name:
Last Name:CALLAHAN
Suffix:
Gender:F
Credentials:PMHNP-BC, CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 3RD AVE SE
Mailing Address - Street 2:
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-3636
Mailing Address - Country:US
Mailing Address - Phone:443-790-9605
Mailing Address - Fax:
Practice Address - Street 1:539 BENFIELD RD STE 2
Practice Address - Street 2:
Practice Address - City:SEVERNA PARK
Practice Address - State:MD
Practice Address - Zip Code:21146-2511
Practice Address - Country:US
Practice Address - Phone:410-513-4513
Practice Address - Fax:989-217-5103
Is Sole Proprietor?:No
Enumeration Date:2015-10-16
Last Update Date:2020-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR196354363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health