Provider Demographics
NPI:1972896090
Name:DEATON, JO CARNEY (APRN/PMH)
Entity Type:Individual
Prefix:MS
First Name:JO
Middle Name:CARNEY
Last Name:DEATON
Suffix:
Gender:F
Credentials:APRN/PMH
Other - Prefix:
Other - First Name:MARY-JOAN
Other - Middle Name:
Other - Last Name:DEATON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:22 WOODLAWN AVE
Mailing Address - Street 2:APT. A
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-3431
Mailing Address - Country:US
Mailing Address - Phone:443-928-3978
Mailing Address - Fax:
Practice Address - Street 1:22 WOODLAWN AVE
Practice Address - Street 2:APT. A
Practice Address - City:CATONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21228-3431
Practice Address - Country:US
Practice Address - Phone:443-928-3978
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-23
Last Update Date:2011-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR062724364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult