MEDICARE: MRS. MYRTIS MARVELL MCCAIN AGEN-DAVIS PMHNP-BC, FNP-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	163W00000X	Registered Nurse	R157786	MD
2	363LF0000X	Family Nurse Practitioner	R157786	MD
3	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	R157786	MD

General Provider Information

NPI Number	:	1386899961
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MYRTIS MARVELL MCCAIN AGEN-DAVIS PMHNP-BC, FNP-BC

Provider Business Mailing Address
First Line	:	5411 OLD FREDERICK RD STE 2
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21229-2126
Country	:	US
Telephone Number	:	410-775-6394
Fax Number	:	410-881-2477

Provider Business Practice Location Address
First Line	:	5411 OLD FREDERICK RD STE 2
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21229-2126
Country	:	US
Telephone Number	:	410-775-6394
Fax Number	:	410-881-2477

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

Provider Enumeration Date	:	11/24/2008
Last Update Date	:	07/24/2025

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