Healthcare Provider Details

I. General information

NPI: 1114559036
Provider Name (Legal Business Name): JENNIFER G DOUGLAS CRNP, PMHNP, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/08/2020
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10055 RED RUN BLVD STE 200
OWINGS MILLS MD
21117-4867
US

IV. Provider business mailing address

10055 RED RUN BLVD STE 200
OWINGS MILLS MD
21117-4867
US

V. Phone/Fax

Practice location:
  • Phone: 240-345-1055
  • Fax: 240-752-0849
Mailing address:
  • Phone: 240-345-1055
  • Fax: 240-752-0849

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR250262
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR250262
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: