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General NPI Number Information
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NPI Number | 1417632571
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Entity Type | Organization
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Legal Business Name | ARTGEVITY LLC
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Dates
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Enumeration Date | 06/16/2023
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Last Update Date | 11/09/2023
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Provider Practice Location Address
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Address Line | 1566 HARFORD SQUARE DRIVE
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City | EDGEWOOD
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State | MD
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Zip | 21040
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Country | US
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Telephone | 410-937-7897
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Fax |
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Provider Business Mailing Address
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Address Line | 1566 HARFORD SQUARE DRIVE
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City | EDGEWOOD
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State | MD
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Zip | 21040
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Country | US
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Telephone | 410-937-7897
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Fax |
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Authorized Official
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Title or Position | CEO & OWNER
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Name | NIKIA AYANA EVANS
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Credential | MBA
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Telephone | 410-937-7897
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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