MEDICARE: CRYSTAL DARMIKA WHITE RN, MSN, 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	R235444	MD

General Provider Information

NPI Number	:	1245000975
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRYSTAL DARMIKA WHITE RN, MSN, PMHNP-BC

Provider Business Mailing Address
First Line	:	306 W REDWOOD ST STE 201
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21201-1708
Country	:	US
Telephone Number	:	240-353-9181
Fax Number	:

Provider Business Practice Location Address
First Line	:	5501 TWIN KNOLLS RD STE 107
Second Line	:
City	:	COLUMBIA
State	:	MD
Zip	:	21045-3260
Country	:	US
Telephone Number	:	240-981-9861
Fax Number	:

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

Provider Enumeration Date	:	01/04/2024
Last Update Date	:	05/27/2026

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