MEDICARE: KENYA BLAKE CODRINGTON FNP, PMHNP

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	R193409	MD
2	363L00000X	Nurse Practitioner	R193409	MD

General Provider Information

NPI Number	:	1750940466
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENYA BLAKE CODRINGTON FNP, PMHNP

Provider Business Mailing Address
First Line	:	9110 STEBBING WAY APT J
Second Line	:
City	:	LAUREL
State	:	MD
Zip	:	20723-5965
Country	:	US
Telephone Number	:	443-583-4332
Fax Number	:

Provider Business Practice Location Address
First Line	:	9110 STEBBING WAY APT J
Second Line	:
City	:	LAUREL
State	:	MD
Zip	:	20723-5965
Country	:	US
Telephone Number	:	443-583-4332
Fax Number	:

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

Provider Enumeration Date	:	06/07/2019
Last Update Date	:	01/21/2026

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