Provider Demographics
NPI:1558604421
Name:JOSEPH-FAGBUYI, KEDEMAH (FNP, PMHNP)
Entity Type:Individual
Prefix:MISS
First Name:KEDEMAH
Middle Name:
Last Name:JOSEPH-FAGBUYI
Suffix:
Gender:F
Credentials:FNP, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4450 MITCHELLVILLE RD
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20716-3112
Mailing Address - Country:US
Mailing Address - Phone:860-518-7454
Mailing Address - Fax:
Practice Address - Street 1:915 RHODE ISLAND AVE NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20001-4153
Practice Address - Country:US
Practice Address - Phone:202-236-6100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-29
Last Update Date:2023-07-19
Deactivation Date:2013-07-31
Deactivation Code:
Reactivation Date:2016-11-28
Provider Licenses
StateLicense IDTaxonomies
NY649183-1163W00000X
DCRN1043213163W00000X
MDR227421363LP0808X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No163W00000XNursing Service ProvidersRegistered Nurse
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health