Healthcare Provider Details

I. General information

NPI: 1750861910
Provider Name (Legal Business Name): HONORINE KOUAMI NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2018
Last Update Date: 01/14/2025
Certification Date: 12/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

JBAB 238 BROOKLEY DR.
JBAB DC
20032
US

IV. Provider business mailing address

10903 DEBORAH DR
POTOMAC MD
20854-2718
US

V. Phone/Fax

Practice location:
  • Phone: 240-857-7761
  • Fax:
Mailing address:
  • Phone: 703-639-7091
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number0024175950
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License Number0024175950
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: