Provider Demographics
NPI:1750095634
Name:FAIR, JATORIA JYNAI (PMHNP-BC)
Entity type:Individual
Prefix:MISS
First Name:JATORIA
Middle Name:JYNAI
Last Name:FAIR
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 W MOUNT ROYAL AVE UNIT 418
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21217-4588
Mailing Address - Country:US
Mailing Address - Phone:870-514-3080
Mailing Address - Fax:
Practice Address - Street 1:1201 W MOUNT ROYAL AVE UNIT 418
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21217-4588
Practice Address - Country:US
Practice Address - Phone:870-514-3080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-05
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR248439363LP0808X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner