Healthcare Provider Details

I. General information

NPI: 1659659100
Provider Name (Legal Business Name): GARRETT CEDRIC CORDELL RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: GARRETT CEDRIC CORDELL PMHNP-BC

II. Dates (important events)

Enumeration Date: 08/02/2011
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1706 W 7TH ST
FREDERICK MD
21702-4249
US

IV. Provider business mailing address

8861 BRANCH AVE # 1049
CLINTON MD
20735-2632
US

V. Phone/Fax

Practice location:
  • Phone: 240-415-8360
  • Fax:
Mailing address:
  • Phone: 202-599-4941
  • Fax: 301-599-0251

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN66372
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberNP66372
License Number StateDC
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR137573
License Number StateMD
# 4
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR137573
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: