Healthcare Provider Details

I. General information

NPI: 1649892068
Provider Name (Legal Business Name): EDWARD KABII GITHIORA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2020
Last Update Date: 07/10/2025
Certification Date: 07/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2480 LLEWELLYN AVE
FORT MEADE MD
20755-7081
US

IV. Provider business mailing address

2480 LLEWELLYN AVE
FORT MEADE MD
20755-7081
US

V. Phone/Fax

Practice location:
  • Phone: 301-677-8800
  • Fax:
Mailing address:
  • Phone: 301-677-8800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License Number210372-7
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License Number9670
License Number StateMN
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number9670
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: