Provider Demographics
NPI:1720411432
Name:TEKIE, SELAM (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:SELAM
Middle Name:
Last Name:TEKIE
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1121 ANNAPOLIS RD STE 106
Mailing Address - Street 2:
Mailing Address - City:ODENTON
Mailing Address - State:MD
Mailing Address - Zip Code:21113-1633
Mailing Address - Country:US
Mailing Address - Phone:443-862-8249
Mailing Address - Fax:
Practice Address - Street 1:7130 MINSTREL WAY STE 120B
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-5329
Practice Address - Country:US
Practice Address - Phone:443-862-8249
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-16
Last Update Date:2024-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEL1-0043098163W00000X
PARN642929163W00000X
MDR219103363L00000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner