Mavis Kisseadoo, PMHNP in Columbia, MD - Medicare Nurse Practitioner

Mavis Kisseadoo, PMHNP is a medicare enrolled "Nurse Practitioner - Psychiatric/mental Health" in Columbia, Maryland. Her current practice location is 10208 Hickory Ridge Rd Apt 302, Columbia, Maryland. You can reach out to her office (for appointments etc.) via phone at (667) 200-6144.

Mavis Kisseadoo is licensed to practice in Maryland (license number R205356) and she also participates in the medicare program. She does not accept medicare assignments directly but she may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. Her NPI Number is 1366081887.

Contact Information

	Mavis Kisseadoo, PMHNP
	10208 Hickory Ridge Rd Apt 302, Columbia, MD 21044-4688
	(667) 200-6144
	Not Available

Map and Direction

Provider's Profile

Full Name	Mavis Kisseadoo
Gender	Female
Speciality	Nurse Practitioner - Psychiatric/mental Health
Location	10208 Hickory Ridge Rd Apt 302, Columbia, Maryland
Accepts Medicare Assignments	Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.

NPI Data:

NPI Number: 1366081887
Provider Enumeration Date: 01/01/2020
Last Update Date: 01/01/2020

Medicare PECOS Information:

PECOS PAC ID: 5193152205
Enrollment ID: I20200303000836

Medical Identifiers

Medical identifiers for Mavis Kisseadoo such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1366081887	NPI	-	NPPES

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
363LP0808X	Nurse Practitioner - Psychiatric/mental Health	R205356 (Maryland)	Primary

Medicare Reassignments

Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Mavis Kisseadoo allows following entities to bill medicare on her behalf.

Entity Name	Sheppard Pratt Physicians Pa
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1518990712 PECOS PAC ID: 8224937610 Enrollment ID: O20040105000737

Medicare Part D Prescriber Enrollment

Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Mavis Kisseadoo is enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.

Mailing Address and Practice Location

Mailing Address	Practice Location Address
Mavis Kisseadoo, PMHNP 10208 Hickory Ridge Rd Apt 302, Columbia, MD 21044-4688 Ph: (667) 200-6144	Mavis Kisseadoo, PMHNP 10208 Hickory Ridge Rd Apt 302, Columbia, MD 21044-4688 Ph: (667) 200-6144

Reviews and Comments

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Mavis Kisseadoo, PMHNP - Medicare Nurse Practitioner in Columbia, MD