Healthcare Provider Details

I. General information

NPI: 1508892647
Provider Name (Legal Business Name): NANCY KERN FEELEY ANP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2006
Last Update Date: 06/16/2022
Certification Date: 06/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 N WOLFE ST BLDG RM416
BALTIMORE MD
21287-0005
US

IV. Provider business mailing address

6201 GREENLEIGH AVE
MIDDLE RIVER MD
21220-2004
US

V. Phone/Fax

Practice location:
  • Phone: 410-955-5268
  • Fax: 410-367-2258
Mailing address:
  • Phone: 410-933-6423
  • Fax: 314-362-5470

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number2017016496
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR095563
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: