MAVIS KISSEADOO PMHNP
NPI 1366081887
Nurse Practitioner - Psychiatric/Mental Health in Columbia, MD

Q: What is Mavis Kisseadoo's NPI number?

The NPI number for Mavis Kisseadoo is 1366081887. It was assigned to this individual provider in the NPPES registry on January 1, 2020.

Q: What is Mavis Kisseadoo's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Psychiatric/Mental Health, with taxonomy code 363LP0808X.

Q: When was this NPI record last updated?

The NPPES record for Mavis Kisseadoo was last updated on January 1, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since January 01, 2020

10208 HICKORY RIDGE RD APT 302, COLUMBIA, MD 21044(667) 200-6144 Get Directions Write a Review

NPPES record last updated: January 1, 2020. Verified against the NPPES registry weekly; last sync: August 02, 2026.

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About Mavis Kisseadoo Pmhnp NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MAVIS KISSEADOO PMHNP (NPI 1366081887) is an individual psychiatric/mental health provider in Columbia, Maryland, licensed in Maryland (R205356) and active in the NPI registry since January 2020.

NPPES Registry Identity

NPI1366081887

Entity TypeIndividualFemale

Primary Taxonomy363LP0808X

Provider Legal NameMAVIS KISSEADOOCredential: PMHNP

Location Address10208 HICKORY RIDGE RD APT 302Columbia, MD 21044-4688

Mailing Address10208 Hickory Ridge Rd Apt 302Columbia, MD 21044-4688 · (667) 200-6144

Phone(667) 200-6144

Sole ProprietorNo

Enumeration DateJanuary 1, 2020

✔ NPI 1366081887 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · Psychiatric/Mental HealthPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363LP0808X

License✔ Licensed in MD · R205356

10208 HICKORY RIDGE RD APT 302, Columbia, MD 21044

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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Providence Health Plan.Insurance ›

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Mavis Kisseadoo's NPI number?

The NPI number for Mavis Kisseadoo is 1366081887. It was assigned to this individual provider in the NPPES registry on January 1, 2020.

Where is Mavis Kisseadoo located?

Mavis Kisseadoo practices at 10208 Hickory Ridge Rd Apt 302, Columbia, MD 21044. The listed phone number is (667) 200-6144.

What is Mavis Kisseadoo's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Psychiatric/Mental Health, with taxonomy code 363LP0808X.

What insurance does Mavis Kisseadoo accept?

Health plans from Providence Health Plan list Mavis Kisseadoo as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Mavis Kisseadoo was last updated on January 1, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.