Healthcare Provider Details

I. General information

NPI: 1104304948
Provider Name (Legal Business Name): BB HEALTH AND WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2018
Last Update Date: 08/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16905 FLICKERWOOD RD
PARKTON MD
21120-9767
US

IV. Provider business mailing address

16905 FLICKERWOOD RD
PARKTON MD
21120-9767
US

V. Phone/Fax

Practice location:
  • Phone: 410-456-2182
  • Fax: 410-343-0842
Mailing address:
  • Phone: 410-456-2182
  • Fax: 410-343-0842

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR075319
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRO75319
License Number StateMD

VIII. Authorized Official

Name: BEVERLY J. DAVIS BYE
Title or Position: FAMILY AND PMH NURSE PRACTITIONER
Credential: CRNP
Phone: 410-456-2182