Healthcare Provider Details

I. General information

NPI: 1407181431
Provider Name (Legal Business Name): KATHLEEN LOUISE MCCLELLAND RN, CNM, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2009
Last Update Date: 01/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1454 BALTIMORE ANNAPOLIS BLVD
ARNOLD MD
21012-2455
US

IV. Provider business mailing address

1454 BALTIMORE ANNAPOLIS BLVD
ARNOLD MD
21012-2455
US

V. Phone/Fax

Practice location:
  • Phone: 410-626-8982
  • Fax: 410-626-8805
Mailing address:
  • Phone: 410-626-8982
  • Fax: 703-330-3286

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN45812
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number0024063346
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberAC001976
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: