Provider Demographics
NPI:1770848871
Name:NKEMNKENG, CARLSON NCHIAZEH (NP)
Entity Type:Individual
Prefix:
First Name:CARLSON
Middle Name:NCHIAZEH
Last Name:NKEMNKENG
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6305 OGLETHORPE MILL DR
Mailing Address - Street 2:
Mailing Address - City:BRANDYWINE
Mailing Address - State:MD
Mailing Address - Zip Code:20613-5693
Mailing Address - Country:US
Mailing Address - Phone:240-486-4976
Mailing Address - Fax:
Practice Address - Street 1:6305 OGLETHORPE MILL DR
Practice Address - Street 2:
Practice Address - City:BRANDYWINE
Practice Address - State:MD
Practice Address - Zip Code:20613-5693
Practice Address - Country:US
Practice Address - Phone:240-486-4976
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-05
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR210108163WP0808X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health