Healthcare Provider Details

I. General information

NPI: 1063950491
Provider Name (Legal Business Name): CASEY AMANDA MCGINNIS DNP, CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2017
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

795 AQUAHART RD STE 205
GLEN BURNIE MD
21061-3953
US

IV. Provider business mailing address

795 AQUAHART RD STE 205
GLEN BURNIE MD
21061-3953
US

V. Phone/Fax

Practice location:
  • Phone: 410-590-8826
  • Fax: 410-768-1949
Mailing address:
  • Phone: 410-590-8826
  • Fax: 410-768-1949

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAC004587
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: