Healthcare Provider Details

I. General information

NPI: 1063948776
Provider Name (Legal Business Name): ALLYSON JUNE KEMP NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2017
Last Update Date: 05/30/2023
Certification Date: 05/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6501 N CHARLES ST
BALTIMORE MD
21204-6819
US

IV. Provider business mailing address

6501 N CHARLES ST
BALTIMORE MD
21204-6819
US

V. Phone/Fax

Practice location:
  • Phone: 410-938-3000
  • Fax:
Mailing address:
  • Phone: 410-938-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number382459
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR259754
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number402194
License Number StateNY
# 4
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR259754
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: