Healthcare Provider Details

I. General information

NPI: 1184551418
Provider Name (Legal Business Name): JEAN-PAUL NJOM-KONDE CRNP, PMHNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2026
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 DAVINA WAY
GLEN BURNIE MD
21060-8496
US

IV. Provider business mailing address

112 DAVINA WAY 112 DAVINA
GLEN BURNIE MD
21060-8496
US

V. Phone/Fax

Practice location:
  • Phone: 240-476-5812
  • Fax: 240-476-5812
Mailing address:
  • Phone: 240-476-5812
  • Fax: 240-476-5812

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License NumberR173258
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: