Healthcare Provider Details

I. General information

NPI: 1063332237
Provider Name (Legal Business Name): MIATTA SEIBATU GBA KAMARA PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2026
Last Update Date: 07/17/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

814 TOLL HOUSE AVE
FREDERICK MD
21701-4519
US

IV. Provider business mailing address

10901 RHODE ISLAND AVE UNIT 674
BELTSVILLE MD
20704-7528
US

V. Phone/Fax

Practice location:
  • Phone: 240-245-0336
  • Fax:
Mailing address:
  • Phone: 240-245-0336
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR192110
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: