Healthcare Provider Details

I. General information

NPI: 1356775464
Provider Name (Legal Business Name): NICOLAS KUIATE TEKAM PMHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: NICOLAS KUIATE TEKAM PMHNP-BC

II. Dates (important events)

Enumeration Date: 08/26/2013
Last Update Date: 02/21/2022
Certification Date: 01/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9704 BREVARD ST
LAUREL MD
20723-1920
US

IV. Provider business mailing address

6501 N CHARLES ST
BALTIMORE MD
21204-6819
US

V. Phone/Fax

Practice location:
  • Phone: 202-702-4778
  • Fax:
Mailing address:
  • Phone: 202-702-4778
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN215137
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: