Provider Demographics
NPI:1326836776
Name:ALEMAYEHU, KIDIST (NP)
Entity type:Individual
Prefix:
First Name:KIDIST
Middle Name:
Last Name:ALEMAYEHU
Suffix:
Gender:
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12504 BLUE PONDS TER
Mailing Address - Street 2:
Mailing Address - City:BELTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20705-6300
Mailing Address - Country:US
Mailing Address - Phone:703-459-7919
Mailing Address - Fax:
Practice Address - Street 1:6320 AUGUSTA DR STE 600
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22150-2503
Practice Address - Country:US
Practice Address - Phone:703-385-3033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-28
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024185694363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily