Provider Demographics
NPI:1518421973
Name:DOUGLAS, ASIA KIMBERLY
Entity Type:Individual
Prefix:
First Name:ASIA
Middle Name:KIMBERLY
Last Name:DOUGLAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ASIA
Other - Middle Name:
Other - Last Name:SPEARMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP-PMH
Mailing Address - Street 1:5 N BENTZ ST
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21701-4913
Mailing Address - Country:US
Mailing Address - Phone:240-647-9049
Mailing Address - Fax:
Practice Address - Street 1:5 N BENTZ ST
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-4913
Practice Address - Country:US
Practice Address - Phone:240-647-9049
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-29
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR201604363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily