Healthcare Provider Details

I. General information

NPI: 1982461471
Provider Name (Legal Business Name): MACY KINLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2024
Last Update Date: 03/01/2024
Certification Date: 03/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3700 RESERVOIR RD NW
WASHINGTON DC
20007-2111
US

IV. Provider business mailing address

1400 20TH ST NW APT 812
WASHINGTON DC
20036-5995
US

V. Phone/Fax

Practice location:
  • Phone: 202-687-3118
  • Fax:
Mailing address:
  • Phone: 302-388-1061
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN232527
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: