Innovo Life, LLC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

Legal business name

INNOVO LIFE, LLC

Doing business as

Innovo Life Coaching and Consulting Practice

Practice address

8101 Sandy Spring Rd Ste 250
Laurel, MD 20707-3527

Phone

(202) 355-8587

Fax

(202) 478-2919

NPI assigned

Mar 18, 2016

Last updated

Mar 20, 2020By 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

Jessica KennedyNPI 1063762821

Title

Co-Owner/Practice Manager

Phone

(202) 355-8587

Specialties & licenses 1

Addresses

Other names 1

• Innovo Life Coaching and Consulting Practice Doing business as

Medicare fee-for-service enrollment

Enrolled in DC

Enrollment records 1

Practitioners 3

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.

• Isabel Martina Berman, MSW,LGSW

  • Clinical Social Worker
  • Rockville, MD
  • NPI 1770639924

  DC

  Medicare reassignment NPD
• Leighton Kennedy, PMHNP, BC

  • Psychiatric/Mental Health Nurse Practitioner
  • Laurel, MD
  • NPI 1649573346

  DC

  Medicare reassignment NPD
• Jessica Kennedy

  • Counselor
  • Laurel, MD
  • NPI 1063762821
  NPD Authorized official

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

{
    "created_epoch": "1458259200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1584662400000",
    "number": "1730540741",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 212",
            "city": "SIMPSONVILLE",
            "state": "MD",
            "postal_code": "211500212",
            "telephone_number": "202-355-8587"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8101 SANDY SPRING RD STE 250",
            "city": "LAUREL",
            "state": "MD",
            "postal_code": "207073527",
            "telephone_number": "202-355-8587",
            "fax_number": "202-478-2919"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INNOVO LIFE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-03-18",
        "last_updated": "2020-03-20",
        "certification_date": "2020-03-20",
        "status": "A",
        "authorized_official_last_name": "KENNEDY",
        "authorized_official_first_name": "JESSICA",
        "authorized_official_title_or_position": "CO-OWNER/PRACTICE MANAGER",
        "authorized_official_telephone_number": "202-355-8587"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Innovo Life Coaching and Consulting Practice",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Innovo Life Coaching and Consulting Practice",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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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 20, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.