Healthcare Provider Details

I. General information

NPI: 1992413264
Provider Name (Legal Business Name): TSION M MEKONNEN PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/07/2022
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7430 MAYFLOWER CT
SAINT LEONARD MD
20685-2497
US

IV. Provider business mailing address

7430 MAYFLOWER CT
SAINT LEONARD MD
20685-2497
US

V. Phone/Fax

Practice location:
  • Phone: 850-758-6321
  • Fax:
Mailing address:
  • Phone: 850-758-6321
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberNP500023025
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR204985
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN500023025
License Number StateDC
# 4
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR204985
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: