Healthcare Provider Details

I. General information

NPI: 1710579644
Provider Name (Legal Business Name): AMIE KATHERINE CONLEY-ABSTON FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/11/2021
Last Update Date: 12/08/2023
Certification Date: 12/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8930 STANFORD BLVD
COLUMBIA MD
21045-5805
US

IV. Provider business mailing address

110 LEJEUNE WAY
ANNAPOLIS MD
21401-8819
US

V. Phone/Fax

Practice location:
  • Phone: 410-313-6359
  • Fax:
Mailing address:
  • Phone: 304-531-3700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LS0200X
TaxonomySchool Nurse Practitioner
License NumberAC004614
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: