Individual provider Active NPI

Fatoumata Niagado, CRNP-PMH

  • Psychiatric/Mental Health Nurse Practitioner
  • Baltimore, MD
National Provider Identifier
1205458676
Registry record updated Jan 13, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
R218881 Issued in MD
Practice address
700 Washington Blvd
Baltimore, MD 21230-2350
Phone
(410) 343-4343
NPI assigned
May 8, 2020
Last updated
Jan 13, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 13, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X R218881 MD Primary

Addresses

Primary practice location

700 Washington Blvd
Baltimore, MD 21230-2350

Mailing address

225 Persimmon Cir
Reisterstown, MD 21136-6480
Phone (410) 369-6333

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210728002028 MD Practitioner - Nurse Practitioner 2860804713 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Interdynamics, Inc. PastSince Dec 15, 2020 Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1588896000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1610496000000",
    "number": "1205458676",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "225 PERSIMMON CIR",
            "city": "REISTERSTOWN",
            "state": "MD",
            "postal_code": "211366480",
            "telephone_number": "410-369-6333"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 WASHINGTON BLVD",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212302350",
            "telephone_number": "410-343-4343"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NIAGADO",
        "first_name": "FATOUMATA",
        "credential": "CRNP-PMH",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-05-08",
        "last_updated": "2021-01-13",
        "certification_date": "2021-01-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "MD",
            "license": "R218881",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Baltimore, MD

Sources for this page

Verify at the official NPI Registry.