Provider Demographics
NPI:1942010871
Name:POWELL LUDFORD, KAMOYA DAVIA (PMHNP)
Entity type:Individual
Prefix:
First Name:KAMOYA
Middle Name:DAVIA
Last Name:POWELL LUDFORD
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11703 HEARTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:BELTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20705-1576
Mailing Address - Country:US
Mailing Address - Phone:954-860-9838
Mailing Address - Fax:
Practice Address - Street 1:1800 N CHARLES ST STE 808
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-5999
Practice Address - Country:US
Practice Address - Phone:954-860-9838
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-13
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR244504363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health