Provider Demographics
NPI:1851793616
Name:KELLY, KARA (NP-C)
Entity type:Individual
Prefix:
First Name:KARA
Middle Name:
Last Name:KELLY
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9503 BURGEE PL
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21704-7842
Mailing Address - Country:US
Mailing Address - Phone:240-559-8786
Mailing Address - Fax:
Practice Address - Street 1:14800 PHYSICIANS LN STE 231
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-3948
Practice Address - Country:US
Practice Address - Phone:301-762-6686
Practice Address - Fax:301-762-6646
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-23
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR205420202D00000X, 363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No202D00000XAllopathic & Osteopathic PhysiciansIntegrative Medicine
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily