Provider Demographics
NPI:1801154471
Name:BAYUGA, KEHBILA EVONCE
Entity type:Individual
Prefix:
First Name:KEHBILA
Middle Name:EVONCE
Last Name:BAYUGA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5021 TOWNSEND WAY APT C3
Mailing Address - Street 2:
Mailing Address - City:BLADENSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20710-1880
Mailing Address - Country:US
Mailing Address - Phone:240-330-3547
Mailing Address - Fax:
Practice Address - Street 1:1480 GOOD HOPE RD SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20020-5615
Practice Address - Country:US
Practice Address - Phone:202-558-2448
Practice Address - Fax:202-204-5758
Is Sole Proprietor?:No
Enumeration Date:2012-05-02
Last Update Date:2024-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC1055857163WP0808X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator