Impact Healthcare Services LLC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

Legal business name

IMPACT HEALTHCARE SERVICES LLC

Practice address

11571 Laurelwalk Dr
Laurel, MD 20708-3001

Phone

(240) 646-2414

NPI assigned

Mar 18, 2025

Last updated

Mar 18, 2025By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Taiwo AdeyemoNPI 1669945879

Title

Co-Owner

Phone

(240) 646-2414

Specialties & licenses 2

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Taiwo O Adeyemo

  • Psychiatric/Mental Health Nurse Practitioner
  • Laurel, MD
  • NPI 1669945879
  NPD Authorized official

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

{
    "created_epoch": "1742256000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1742256000000",
    "number": "1609676691",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11571 LAURELWALK DR",
            "city": "LAUREL",
            "state": "MD",
            "postal_code": "207083001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11571 LAURELWALK DR",
            "city": "LAUREL",
            "state": "MD",
            "postal_code": "207083001",
            "telephone_number": "240-646-2414"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IMPACT HEALTHCARE SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-03-18",
        "last_updated": "2025-03-18",
        "certification_date": "2025-03-18",
        "status": "A",
        "authorized_official_last_name": "ADEYEMO",
        "authorized_official_first_name": "TAIWO",
        "authorized_official_title_or_position": "CO-OWNER",
        "authorized_official_telephone_number": "240-646-2414"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Psychiatric/Mental Health Nurse Practitioner in Laurel, MD
• Providers in Laurel, MD by specialty
• Psychiatric/Mental Health Nurse Practitioner in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.