Provider Demographics
NPI:1124015300
Name:NELMS, KRISTEN MILIO (CRNP)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:MILIO
Last Name:NELMS
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:MILIO
Other - Last Name:COLUMBIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:301 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-5803
Mailing Address - Country:US
Mailing Address - Phone:410-553-8300
Mailing Address - Fax:
Practice Address - Street 1:301 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-5803
Practice Address - Country:US
Practice Address - Phone:410-553-8300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-03
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR152210363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCF591-0025OtherCARE FIRST DC
6784OtherBRAVO HEALTH
MD643255-02OtherCARE FIRST MARYLAND RENDERING NUMBER
MD406267100Medicaid
MD643255-02OtherCARE FIRST MARYLAND RENDERING NUMBER
S966K089Medicare ID - Type Unspecified
MDKSO4060Medicare PIN