MEDICARE: KEONIE MORRISEY PMHNP- BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	R223611	MD

General Provider Information

NPI Number	:	1013761360
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEONIE MORRISEY PMHNP- BC

Provider Business Mailing Address
First Line	:	5014 FOREST PINES DR
Second Line	:
City	:	UPPER MARLBORO
State	:	MD
Zip	:	20772-2688
Country	:	US
Telephone Number	:	240-428-9191
Fax Number	:

Provider Business Practice Location Address
First Line	:	5014 FOREST PINES DR
Second Line	:
City	:	UPPER MARLBORO
State	:	MD
Zip	:	20772-2688
Country	:	US
Telephone Number	:	240-428-9191
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/15/2024
Last Update Date	:	04/15/2024

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