Siyami Egbase Takha, CRNP

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

R194882 Issued in MD

Practice address

12070 Old Line Ctr Ste 211
Saint Charles, MD 20602-2567

Phone

(202) 600-6748

Fax

(800) 521-0943

NPI assigned

Nov 8, 2017

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in DC, MD2 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, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Awesome Experience Psychiatric Services LLCGroup PAC ID 0143635342, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: awesomeexperiencepsychiatricservices.siyami.takha@158179.advancedmd-direct.com
• Direct secure messaging: stakha@wellpath.us

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

• Awesome Experience Psychiatric Services LLC

  • Multi-Specialty Clinic/Center
  • Saint Charles, MD
  • NPI 1457949018
  Medicare reassignment Care Compare group NPD Authorized official
• Premier Health Care, LLC

  • Psychiatry Physician
  • Silver Spring, MD
  • NPI 1285017822

  DC

  Medicare reassignment NPD
• Psychogeriatric Services LLC

  • Psychiatry Physician
  • Columbia, MD
  • NPI 1588689483

  DC

  Medicare reassignment NPD
• McClendon Center

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Washington, DC
  • NPI 1396778361
  Medicare reassignment NPD
• Premier Health Care LLC

  • Internal Medicine Physician
  • Clinton, MD
  • NPI 1528538758
  NPD

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

{
    "created_epoch": "1510099200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1772668800000",
    "number": "1760995021",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12070 OLD LINE CTR STE 211",
            "city": "SAINT CHARLES",
            "state": "MD",
            "postal_code": "206022567",
            "telephone_number": "202-600-6748",
            "fax_number": "800-521-0943"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12070 OLD LINE CTR STE 211",
            "city": "SAINT CHARLES",
            "state": "MD",
            "postal_code": "206022567",
            "telephone_number": "202-600-6748",
            "fax_number": "800-521-0943"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "30007 Business Center Dr",
            "address_purpose": "LOCATION",
            "city": "Charlotte Hall",
            "state": "MD",
            "postal_code": "20622",
            "country_code": "US",
            "telephone_number": "301-997-1300 x30199",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TAKHA",
        "first_name": "SIYAMI",
        "middle_name": "EGBASE",
        "name_prefix": "Ms.",
        "credential": "CRNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-11-08",
        "last_updated": "2026-03-05",
        "certification_date": "2026-03-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "MD",
            "license": "R194882",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "MD",
            "license": "R194882",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "stakha@Wellpath.us",
            "affiliation": "N",
            "endpointDescription": "Email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "other",
            "address_1": "30007 Business Center Dr",
            "city": "Charlotte Hall",
            "state": "MD",
            "country_code": "US",
            "postal_code": "206223101",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Twanda Chapman
• Audrey Diehl
• Jessica Khoury, MD
• Kingdom Hearts of Service
• Northwest Pediatrics Inc

• Psychiatric/Mental Health Nurse Practitioner in Saint Charles, MD
• Providers in Saint Charles, 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 5, 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.