Healthcare Provider Details

I. General information

NPI: 1366077133
Provider Name (Legal Business Name): YAH ROCHELLE KILIKPO CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/11/2020
Last Update Date: 09/27/2022
Certification Date: 09/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 SAINT PAUL ST STE 605
BALTIMORE MD
21202-2102
US

IV. Provider business mailing address

1589 SULPHUR SPRING RD STE 109
BALTIMORE MD
21227-2542
US

V. Phone/Fax

Practice location:
  • Phone: 410-332-1111
  • Fax: 410-332-1752
Mailing address:
  • Phone: 443-575-4880
  • Fax: 443-575-4891

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP021282
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR255289
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: