Healthcare Provider Details

I. General information

NPI: 1770424475
Provider Name (Legal Business Name): KEONA CROWDER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2026
Last Update Date: 04/06/2026
Certification Date: 04/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2024 N SMALLWOOD ST
BALTIMORE MD
21216-3218
US

IV. Provider business mailing address

2024 N SMALLWOOD ST
BALTIMORE MD
21216-3218
US

V. Phone/Fax

Practice location:
  • Phone: 410-908-6328
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: