Provider Demographics
NPI:1790043586
Name:NKEMGANG, PHILIP (NP)
Entity type:Individual
Prefix:
First Name:PHILIP
Middle Name:
Last Name:NKEMGANG
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4804 LAKEVIEW LN
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20720-4247
Mailing Address - Country:US
Mailing Address - Phone:240-603-8148
Mailing Address - Fax:
Practice Address - Street 1:4804 LAKEVIEW LN
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20720-4247
Practice Address - Country:US
Practice Address - Phone:240-603-8148
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-30
Last Update Date:2025-08-28
Deactivation Date:2025-07-31
Deactivation Code:
Reactivation Date:2025-08-20
Provider Licenses
StateLicense IDTaxonomies
MDR189698163WP0807X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WP0807XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Child & AdolescentGroup - Single Specialty