Healthcare Provider Details

I. General information

NPI: 1487794095
Provider Name (Legal Business Name): KELLY ELIZABETH LINERO PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 04/26/2021
Certification Date: 04/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2333 ONTARIO RD NW
WASHINGTON DC
20009-2627
US

IV. Provider business mailing address

2333 ONTARIO RD NW
WASHINGTON DC
20009-2627
US

V. Phone/Fax

Practice location:
  • Phone: 202-483-8196
  • Fax: 202-232-2745
Mailing address:
  • Phone: 202-483-8196
  • Fax: 202-232-2745

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA031154
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: