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Organization
PREMIER PSYCHIATRY, LLC
Active
Organization
PREMIER PSYCHIATRY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TROY G MODISETTE CRNP (OWNER/OPERATOR)
(443) 742-9167
Entity
Organization
Contact information
Practice address
10601 VIRGINIA AVE, COCKEYSVILLE, MD 21030-2315
(443) 353-9184
Mailing address
10601 VIRGINIA AVE, COCKEYSVILLE, MD 21030-2315
(443) 742-9167
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
09/24/2020
Last updated
10/31/2020
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