MEDICARE: TA'KISHA A. TERRELL CRNP

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	R184739	MD

General Provider Information

NPI Number	:	1154255594
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TA'KISHA A. TERRELL CRNP

Provider Business Mailing Address
First Line	:	8507 OXON HILL RD., SUITE 200
Second Line	:	#1189
City	:	FORT WASHINGTON
State	:	MD
Zip	:	20744
Country	:	US
Telephone Number	:	240-229-6741
Fax Number	:

Provider Business Practice Location Address
First Line	:	4500 FORBES BLVD STE W1
Second Line	:
City	:	LANHAM
State	:	MD
Zip	:	20706-6312
Country	:	US
Telephone Number	:	240-229-6741
Fax Number	:

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

Provider Enumeration Date	:	06/10/2026
Last Update Date	:	06/10/2026

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