Dwayne Omar Ennis, PMHNP-BC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

R173805 Issued in MD

Practice address

1014 Washington Ave
La Plata, MD 20646-4228

Phone

(917) 560-5145

NPI assigned

Oct 21, 2024

Last updated

Feb 6, 2026By the provider in NPPES

Sex

Male

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 MD, DC2 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

Specialty

Nurse Practitioner

Education

Other, 2014

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Axis Healthcare GroupGroup PAC ID 1254409550, 76 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

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.

• Axis Healthcare Group

  dba CareMind Health

  • Psychiatry Physician
  • Silver Spring, MD
  • NPI 1326295098

  DC

  Medicare reassignment Care Compare group NPD
• MCS, PC

  dba Mindoula Health, Inc.

  • Community/Behavioral Health Agency
  • Silver Spring, MD
  • NPI 1538717723

  Psychiatric/Mental Health

  NPD (past)

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

{
    "created_epoch": "1729468800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1770336000000",
    "number": "1700607835",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1014 WASHINGTON AVE",
            "city": "LA PLATA",
            "state": "MD",
            "postal_code": "206464228"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1014 WASHINGTON AVE",
            "city": "LA PLATA",
            "state": "MD",
            "postal_code": "206464228",
            "telephone_number": "917-560-5145"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "8040 Georgia Ave Ste 170",
            "address_purpose": "LOCATION",
            "city": "Silver Spring",
            "state": "MD",
            "postal_code": "209104959",
            "country_code": "US",
            "telephone_number": "202-360-4787",
            "fax_number": "202-360-4787",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ENNIS",
        "first_name": "DWAYNE",
        "middle_name": "OMAR",
        "credential": "PMHNP-BC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-10-21",
        "last_updated": "2026-02-06",
        "certification_date": "2026-02-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "MD",
            "license": "R173805",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ebony Edwards
• Emed Medical Supply, LLC
• Emergency Medicine Associates
• Emergency Medicine Associates PA PC
• Kirstin English, LMSW
• Srinivas Erukulla
• Emily Rose Estep
• Michael Etts, LCSW-C, ACH
• Olimpia Fiore Etts, LCSW-C
• Joseph Daniel Evans, CF-SLP

• Psychiatric/Mental Health Nurse Practitioner in La Plata, MD
• Providers in La Plata, 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 Feb 6, 2026; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.