Provider Demographics
NPI:1598400947
Name:DAVIS, YOLANDA TI'ESHA (PMHNP-BC, CRNP-PMH)
Entity Type:Individual
Prefix:MS
First Name:YOLANDA
Middle Name:TI'ESHA
Last Name:DAVIS
Suffix:
Gender:F
Credentials:PMHNP-BC, CRNP-PMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 66142
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21239-6142
Mailing Address - Country:US
Mailing Address - Phone:410-419-0314
Mailing Address - Fax:
Practice Address - Street 1:5026 CAMPBELL BLVD STE H
Practice Address - Street 2:
Practice Address - City:NOTTINGHAM
Practice Address - State:MD
Practice Address - Zip Code:21236-5051
Practice Address - Country:US
Practice Address - Phone:410-780-2692
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-30
Last Update Date:2022-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR229013363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health