Provider Demographics
NPI:1093090284
Name:KELLY-WILLIAMS, DEBORAH CARINA (CRNP)
Entity type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:CARINA
Last Name:KELLY-WILLIAMS
Suffix:
Gender:
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9524 TWILIGHT CT
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21046-1954
Mailing Address - Country:US
Mailing Address - Phone:301-725-9732
Mailing Address - Fax:301-725-9732
Practice Address - Street 1:2425 25TH ST SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20020-3409
Practice Address - Country:US
Practice Address - Phone:240-432-3022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-19
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR144348363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology