Provider Demographics
NPI:1124802632
Name:KELLY, KAREN DOLORES (PCD)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:DOLORES
Last Name:KELLY
Suffix:
Gender:F
Credentials:PCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3498 BLACKBERRY LN
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042-1204
Mailing Address - Country:US
Mailing Address - Phone:410-707-6656
Mailing Address - Fax:
Practice Address - Street 1:3498 BLACKBERRY LN
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21042-1204
Practice Address - Country:US
Practice Address - Phone:410-707-6656
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-24
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula