MEDICARE: KEHBILA EVONCE BAYUGA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WP0808X	Psychiatric/Mental Health Registered Nurse	1055857	DC
2	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1801154471
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEHBILA EVONCE BAYUGA

Provider Business Mailing Address
First Line	:	5021 TOWNSEND WAY APT C3
Second Line	:
City	:	BLADENSBURG
State	:	MD
Zip	:	20710-1880
Country	:	US
Telephone Number	:	240-330-3547
Fax Number	:

Provider Business Practice Location Address
First Line	:	1480 GOOD HOPE RD SE
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20020-5615
Country	:	US
Telephone Number	:	202-558-2448
Fax Number	:	202-204-5758

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/02/2012
Last Update Date	:	09/28/2024

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Directions to “ KEHBILA EVONCE BAYUGA ” Practice Location

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