Provider Demographics
NPI:1235386939
Name:GANTT, JENDAYI (DNP, CNM, PMHNP-BC)
Entity type:Individual
Prefix:DR
First Name:JENDAYI
Middle Name:
Last Name:GANTT
Suffix:
Gender:F
Credentials:DNP, CNM, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4690 MILLENNIUM DR STE 300
Mailing Address - Street 2:
Mailing Address - City:BELCAMP
Mailing Address - State:MD
Mailing Address - Zip Code:21017-1527
Mailing Address - Country:US
Mailing Address - Phone:443-255-6499
Mailing Address - Fax:
Practice Address - Street 1:4690 MILLENNIUM DR STE 300
Practice Address - Street 2:
Practice Address - City:BELCAMP
Practice Address - State:MD
Practice Address - Zip Code:21017-1527
Practice Address - Country:US
Practice Address - Phone:443-255-6499
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-25
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR163670367A00000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDR163670OtherSTATE LICENSE
DELK-0000153OtherSTATE LICENSE