MEDICARE: KELLY JANE KIRKPATRICK

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	LC4113	MD

General Provider Information

NPI Number	:	1851669311
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY JANE KIRKPATRICK

Provider Business Mailing Address
First Line	:	1311 ORCHARD WAY
Second Line	:
City	:	FREDERICK
State	:	MD
Zip	:	21703-6090
Country	:	US
Telephone Number	:	240-415-8733
Fax Number	:

Provider Business Practice Location Address
First Line	:	1311 ORCHARD WAY
Second Line	:
City	:	FREDERICK
State	:	MD
Zip	:	21703-6090
Country	:	US
Telephone Number	:	240-415-8733
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/12/2011
Last Update Date	:	02/04/2017

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