Healthcare Provider Details

I. General information

NPI: 1982112843
Provider Name (Legal Business Name): JIMMY AKANBI BELLO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2018
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7836 OAKWOOD RD STE A
GLEN BURNIE MD
21061-4298
US

IV. Provider business mailing address

12101 GORDON AVE
BELTSVILLE MD
20705-1173
US

V. Phone/Fax

Practice location:
  • Phone: 410-768-6011
  • Fax: 410-768-0101
Mailing address:
  • Phone: 301-792-0613
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR137969
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR137969
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: