Healthcare Provider Details

I. General information

NPI: 1093090284
Provider Name (Legal Business Name): DEBORAH CARINA KELLY-WILLIAMS CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2011
Last Update Date: 05/07/2025
Certification Date: 05/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2425 25TH ST SE
WASHINGTON DC
20020-3409
US

IV. Provider business mailing address

9524 TWILIGHT CT
COLUMBIA MD
21046-1954
US

V. Phone/Fax

Practice location:
  • Phone: 240-432-3022
  • Fax:
Mailing address:
  • Phone: 301-725-9732
  • Fax: 301-725-9732

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberR144348
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: