MEDICARE: FATMATA KAMARA RN

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	163W00000X	Registered Nurse	0002099869	DC
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	NP500005866	DC
3	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1093410789
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FATMATA KAMARA RN

Provider Business Mailing Address
First Line	:	4117 BROOKGREEN DR
Second Line	:
City	:	FAIRFAX
State	:	VA
Zip	:	22033-6220
Country	:	US
Telephone Number	:	571-265-5969
Fax Number	:

Provider Business Practice Location Address
First Line	:	2811 PENNSYLVANIA AVE SE STE LL
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20020-3865
Country	:	US
Telephone Number	:	202-894-6811
Fax Number	:

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

Provider Enumeration Date	:	04/03/2023
Last Update Date	:	01/05/2026

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