Provider Demographics
NPI:1841750205
Name:KENGNI, JOSYANE MARLYSE (PMHNP)
Entity Type:Individual
Prefix:
First Name:JOSYANE
Middle Name:MARLYSE
Last Name:KENGNI
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5301 BUCKEYSTOWN PIKE
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21704-8370
Mailing Address - Country:US
Mailing Address - Phone:301-246-0423
Mailing Address - Fax:443-279-0537
Practice Address - Street 1:5301 BUCKEYSTOWN PIKE STE 308
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21704-8373
Practice Address - Country:US
Practice Address - Phone:301-246-0423
Practice Address - Fax:949-655-7796
Is Sole Proprietor?:No
Enumeration Date:2019-03-21
Last Update Date:2023-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR210262363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health