Provider Demographics
NPI:1184748667
Name:PSYCHIATRIC NURSE PRACTITIONER ASSOCIATE, LLC
Entity type:Organization
Organization Name:PSYCHIATRIC NURSE PRACTITIONER ASSOCIATE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIC NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP,BC
Authorized Official - Phone:301-907-6695
Mailing Address - Street 1:4401 E WEST HWY
Mailing Address - Street 2:SUITE 206 B
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-4523
Mailing Address - Country:US
Mailing Address - Phone:301-907-6695
Mailing Address - Fax:301-907-6771
Practice Address - Street 1:4401 E WEST HWY
Practice Address - Street 2:SUITE 206 B
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-4523
Practice Address - Country:US
Practice Address - Phone:301-907-6695
Practice Address - Fax:301-907-6771
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR121391363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty