Healthcare Provider Details

I. General information

NPI: 1891137097
Provider Name (Legal Business Name): KAREN A HENNESSY CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2013
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4405 E WEST HWY STE 311B
BETHESDA MD
20814-4534
US

IV. Provider business mailing address

2900 THE CONCORD CT
ELLICOTT CITY MD
21042-2170
US

V. Phone/Fax

Practice location:
  • Phone: 301-479-6966
  • Fax: 866-795-0725
Mailing address:
  • Phone: 301-479-6966
  • Fax: 866-795-0725

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR096333
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: