Provider Demographics
NPI:1912544230
Name:KIND HEART WELLNESS SERVICES, INC
Entity Type:Organization
Organization Name:KIND HEART WELLNESS SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:CHINAGOROM
Authorized Official - Last Name:OKORIE-ANOCHIE
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP
Authorized Official - Phone:443-600-2400
Mailing Address - Street 1:31 HOWARD ST
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:MD
Mailing Address - Zip Code:21001-2445
Mailing Address - Country:US
Mailing Address - Phone:443-543-8432
Mailing Address - Fax:
Practice Address - Street 1:31 HOWARD ST
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:MD
Practice Address - Zip Code:21001-2445
Practice Address - Country:US
Practice Address - Phone:443-600-2400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-05
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD587074700Medicaid