Healthcare Provider Details

I. General information

NPI: 1609617505
Provider Name (Legal Business Name): KRISTIN PRATHER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2024
Last Update Date: 12/22/2025
Certification Date: 12/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 S CLINTON ST
BALTIMORE MD
21224-5730
US

IV. Provider business mailing address

14211 SHOREHAM DR
SILVER SPRING MD
20905-4479
US

V. Phone/Fax

Practice location:
  • Phone: 301-467-7893
  • Fax:
Mailing address:
  • Phone: 301-467-7893
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR193900
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: