Provider Demographics
NPI:1528685161
Name:NURSE PRACTITIONER ON CALL LLC
Entity type:Organization
Organization Name:NURSE PRACTITIONER ON CALL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KELVINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:KAMARA
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP
Authorized Official - Phone:240-619-9180
Mailing Address - Street 1:1002 CORTANA CT
Mailing Address - Street 2:
Mailing Address - City:SEVERN
Mailing Address - State:MD
Mailing Address - Zip Code:21144-1184
Mailing Address - Country:US
Mailing Address - Phone:240-619-9180
Mailing Address - Fax:
Practice Address - Street 1:1800 N CHARLES ST STE 804
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-5987
Practice Address - Country:US
Practice Address - Phone:240-898-1810
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NURSE PRACTITIONER ON CALL LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-06-30
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD258824200Medicaid
MD585449100Medicaid