Provider Demographics
NPI:1356775464
Name:KUIATE TEKAM, NICOLAS (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:NICOLAS
Middle Name:
Last Name:KUIATE TEKAM
Suffix:
Gender:M
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:NICOLAS
Other - Middle Name:
Other - Last Name:KUIATE TEKAM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PMHNP-BC
Mailing Address - Street 1:6501 N CHARLES ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21204-6819
Mailing Address - Country:US
Mailing Address - Phone:202-702-4778
Mailing Address - Fax:
Practice Address - Street 1:9704 BREVARD ST
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20723-1920
Practice Address - Country:US
Practice Address - Phone:202-702-4778
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-26
Last Update Date:2022-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDRN215137363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty