Kadiatou Diallo-Bangurah, PMHNP

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

SP030869 Issued in PA

Practice address

106 Derry Heights Blvd
Lewistown, PA 17044-8648

Phone

(717) 447-0340

Fax

(717) 447-0344

NPI assigned

May 2, 2012

Reactivated

Jan 29, 2024

Last updated

Oct 18, 2024By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA, PA2 enrollments

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 2

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kadiatoudiallobangurah@primaryhn.medalliesdirect.net

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.

• Primary Health Network

  • Federally Qualified Health Center (FQHC)
  • Sharon, PA
  • NPI 1417932609
  Medicare reassignment NPD
• Primary Health Network

  • Federally Qualified Health Center (FQHC)
  • Emlenton, PA
  • NPI 1750181038
  NPD
• Brain Psychiatry Inc

  • Psychiatric/Mental Health Nurse Practitioner
  • Rancho Cucamonga, CA
  • NPI 1841066800
  NPD

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

{
    "created_epoch": "1335916800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1729209600000",
    "number": "1639437254",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 SHENANGO AVE",
            "city": "SHARON",
            "state": "PA",
            "postal_code": "161461503",
            "telephone_number": "717-447-0340",
            "fax_number": "717-447-0344"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "106 DERRY HEIGHTS BLVD",
            "city": "LEWISTOWN",
            "state": "PA",
            "postal_code": "170448648",
            "telephone_number": "717-447-0340",
            "fax_number": "717-447-0344"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DIALLO-BANGURAH",
        "first_name": "KADIATOU",
        "credential": "PMHNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-05-02",
        "last_updated": "2024-10-18",
        "certification_date": "2024-10-18",
        "deactivation_date": "2023-11-30",
        "reactivation_date": "2024-01-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "PA",
            "license": "SP030869",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kimberly Kathleen Deutsch, PMHNP
• Dennis M Devita, M.D.
• Lauren Devita, D.O.
• Kushaljit S Dhesi, MD
• Diakon Lutheran Social Ministries (Ohesson Manor)
• Abigail Frances Digilio, PT
• Harry Edward Dilcher, M.D.
• Harry Heasley Dinsmore Jr., MD
• Daniel William Doberneck, O.D.
• Karen Graham Doberneck, PHD, BCBA-D

• Psychiatric/Mental Health Nurse Practitioner in Lewistown, PA
• Providers in Lewistown, PA by specialty
• Psychiatric/Mental Health Nurse Practitioner in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.