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Organization
MALAMA MEDICAL
Active
Organization
MALAMA MEDICAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIMELA JEAN FERGUSON NP (CHIEF EXECUTIVE OFFICER)
(443) 802-5130
Entity
Organization
Contact information
Practice address
4604 YORK RD, BALTIMORE, MD 21212-4726
(443) 802-5130
Mailing address
34 YORK CT, BALTIMORE, MD 21218-1248
(443) 802-5130
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
NULL
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Enumeration date
08/26/2019
Last updated
02/01/2021
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