Provider Demographics
NPI:1962714204
Name:NGONA, KETTY M (CRNP)
Entity type:Individual
Prefix:
First Name:KETTY
Middle Name:M
Last Name:NGONA
Suffix:
Gender:
Credentials:CRNP
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Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7735 HOLLINS CHAPEL CT
Mailing Address - Street 2:
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21060-8396
Mailing Address - Country:US
Mailing Address - Phone:443-491-7854
Mailing Address - Fax:443-288-4808
Practice Address - Street 1:7310 RITCHIE HWY STE 612
Practice Address - Street 2:
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-3291
Practice Address - Country:US
Practice Address - Phone:443-491-7854
Practice Address - Fax:443-288-4808
Is Sole Proprietor?:No
Enumeration Date:2010-07-01
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDR170567363LA2200X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health