Healthcare Provider Details

I. General information

NPI: 1912262015
Provider Name (Legal Business Name): MARY MIATTA KARGBO HHA, REGISTERED NURS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2012
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2637 NICHOLSON ST APT 103
HYATTSVILLE MD
20782-2661
US

IV. Provider business mailing address

15405 EMMANUAL WAY
BOWIE MD
20716-1265
US

V. Phone/Fax

Practice location:
  • Phone: 202-545-0935
  • Fax: 202-545-0934
Mailing address:
  • Phone: 240-706-4347
  • Fax: 240-706-4347

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN1044787
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: