Provider Demographics
NPI:1336964964
Name:KRISSEY MEDICAL AND MENTAL HEALTH
Entity type:Organization
Organization Name:KRISSEY MEDICAL AND MENTAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-546-7696
Mailing Address - Street 1:10111 MARTIN LUTHER KING JR HWY STE 101
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20720-4231
Mailing Address - Country:US
Mailing Address - Phone:248-470-3427
Mailing Address - Fax:240-334-2558
Practice Address - Street 1:10111 MARTIN LUTHER KING JR HWY STE 101
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20720-4231
Practice Address - Country:US
Practice Address - Phone:248-470-3427
Practice Address - Fax:240-334-2558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-19
Last Update Date:2024-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty