=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679287429
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KEMREM HEALTHCARE LIMITED LIABILITY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/06/2023
-----------------------------------------------------
Last Update Date | 03/22/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2333 BALTIMORE BLVD STE A
-----------------------------------------------------
City | FINKSBURG
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21048-1751
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-900-9929
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2408 HENSON DR
-----------------------------------------------------
City | MARRIOTTSVILLE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21104-1162
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-900-9929
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PMHNP-BC
-----------------------------------------------------
Name | MRS. CHRISTIANA OLAYERA-AKINBOYE
-----------------------------------------------------
Credential | NP
-----------------------------------------------------
Telephone | 410-900-9929
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0801X
-----------------------------------------------------
Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------