MEDICARE: TAOHEED KASUMU FNP-C

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	363LF0000X	Family Nurse Practitioner	0024195998	VA
2	363LF0000X	Family Nurse Practitioner	R257759	MD

General Provider Information

NPI Number	:	1164266532
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAOHEED KASUMU FNP-C

Provider Business Mailing Address
First Line	:	1636 BELLE VIEW BLVD
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22307-6531
Country	:	US
Telephone Number	:	866-389-2727
Fax Number	:

Provider Business Practice Location Address
First Line	:	1636 BELLE VIEW BLVD
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22307-6531
Country	:	US
Telephone Number	:	866-389-2727
Fax Number	:

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

Provider Enumeration Date	:	06/20/2024
Last Update Date	:	03/05/2026

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