Healthcare Provider Details

I. General information

NPI: 1467717298
Provider Name (Legal Business Name): KATIE CREIGHTON NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2012
Last Update Date: 09/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 MEDICAL PKWY WAYSON PAVILLION, SUITE 350
ANNAPOLIS MD
21401-3280
US

IV. Provider business mailing address

600 RIDGELY AVE STE 231
ANNAPOLIS MD
21401-1092
US

V. Phone/Fax

Practice location:
  • Phone: 443-481-1966
  • Fax:
Mailing address:
  • Phone: 443-481-1966
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR185765
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: