Provider Demographics
NPI:1962248518
Name:YOUNTI, KELLY NGIMNKIA DJOUBOU
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:NGIMNKIA DJOUBOU
Last Name:YOUNTI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3636 TYROL DR BLDG 3636
Mailing Address - Street 2:
Mailing Address - City:GLENARDEN
Mailing Address - State:MD
Mailing Address - Zip Code:20774-2617
Mailing Address - Country:US
Mailing Address - Phone:240-639-2342
Mailing Address - Fax:
Practice Address - Street 1:3636 TYROL DR BLDG 3636
Practice Address - Street 2:
Practice Address - City:GLENARDEN
Practice Address - State:MD
Practice Address - Zip Code:20774-2617
Practice Address - Country:US
Practice Address - Phone:240-639-2342
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-03
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No374U00000XNursing Service Related ProvidersHome Health Aide