Healthcare Provider Details

I. General information

NPI: 1932934635
Provider Name (Legal Business Name): JACQUELINE M BINNS PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2024
Last Update Date: 09/04/2024
Certification Date: 09/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 466
COLUMBIA MD
21045-0466
US

IV. Provider business mailing address

PO BOX 466
COLUMBIA MD
21045-0466
US

V. Phone/Fax

Practice location:
  • Phone: 301-250-8427
  • Fax: 800-918-4110
Mailing address:
  • Phone: 301-250-8427
  • Fax: 800-918-4110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number106882
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: