Healthcare Provider Details

I. General information

NPI: 1386899961
Provider Name (Legal Business Name): MYRTIS MARVELL MCCAIN AGEN-DAVIS PMHNP-BC, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/24/2008
Last Update Date: 07/24/2025
Certification Date: 07/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5411 OLD FREDERICK RD STE 2
BALTIMORE MD
21229-2126
US

IV. Provider business mailing address

5411 OLD FREDERICK RD STE 2
BALTIMORE MD
21229-2126
US

V. Phone/Fax

Practice location:
  • Phone: 410-775-6394
  • Fax: 410-881-2477
Mailing address:
  • Phone: 410-775-6394
  • Fax: 410-881-2477

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR157786
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR157786
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR157786
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: