Healthcare Provider Details

I. General information

NPI: 1740096270
Provider Name (Legal Business Name): HABSATU AMINATA KABIA PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/09/2024
Last Update Date: 12/31/2025
Certification Date: 12/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10303 BALD HILL RD
BOWIE MD
20721-2839
US

IV. Provider business mailing address

10303 BALD HILL RD
BOWIE MD
20721-2839
US

V. Phone/Fax

Practice location:
  • Phone: 240-704-3940
  • Fax: 240-387-6946
Mailing address:
  • Phone: 240-704-3940
  • Fax: 240-387-6946

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberNP1049080
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number2024072992
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: