Provider Demographics
NPI:1124781356
Name:BROWN-GROSS, KIMBERLY PATRICE (CRNP-PMH)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:PATRICE
Last Name:BROWN-GROSS
Suffix:
Gender:F
Credentials:CRNP-PMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8745 WHITTINGTON ST
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20603-7008
Mailing Address - Country:US
Mailing Address - Phone:240-412-4719
Mailing Address - Fax:
Practice Address - Street 1:8745 WHITTINGTON ST
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20603-7008
Practice Address - Country:US
Practice Address - Phone:240-412-4719
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-14
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR149350363LP0808X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health