Healthcare Provider Details

I. General information

NPI: 1467554568
Provider Name (Legal Business Name): KARAN S. KVERNO PMH NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KARAN S. KVERNO PMH CNS

II. Dates (important events)

Enumeration Date: 09/01/2006
Last Update Date: 03/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5601 LOCH RAVEN BLVD MEDSTAR GOOD SAMARITAN, RUSSELL MORGAN BLDG, SUITE 406
BALTIMORE MD
21239-2945
US

IV. Provider business mailing address

5601 LOCH RAVEN BLVD., RUSSELL MORGAN BLD SUITE 406 MEDSTAR GOOD SAMARITAN HOSPITAL, NEUROPSYCHIATRY INSTIT
BALTIMORE MD
21239
US

V. Phone/Fax

Practice location:
  • Phone: 443-444-4540
  • Fax: 855-778-6866
Mailing address:
  • Phone: 443-444-4540
  • Fax: 855-778-6866

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR092427
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License NumberR092427
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: