Provider Demographics
NPI:1659434736
Name:DITTO, JESSICA F (DNP, CPNP-PC, PMHS)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:F
Last Name:DITTO
Suffix:
Gender:F
Credentials:DNP, CPNP-PC, PMHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:658 KENILWORTH DR STE 206
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-2334
Mailing Address - Country:US
Mailing Address - Phone:443-841-7550
Mailing Address - Fax:443-841-7572
Practice Address - Street 1:658 KENILWORTH DR STE 206
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-2334
Practice Address - Country:US
Practice Address - Phone:443-841-7550
Practice Address - Fax:443-841-7572
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR131314363LP0200X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD410208800Medicaid