Healthcare Provider Details

I. General information

NPI: 1124576095
Provider Name (Legal Business Name): BLESSING JIM MATTHEWS MBPA, BS, BSN,RN,FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2016
Last Update Date: 07/28/2025
Certification Date: 07/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8855 ANNAPOLIS RD SUITE 305
LANHAM MD
20706-2924
US

IV. Provider business mailing address

8855 ANNAPOLIS RD SUITE 305
LANHAM MD
20706-2924
US

V. Phone/Fax

Practice location:
  • Phone: 240-770-7774
  • Fax: 240-770-3161
Mailing address:
  • Phone: 240-770-7774
  • Fax: 240-770-3161

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberR129320
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR129320
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: