Healthcare Provider Details

I. General information

NPI: 1649174863
Provider Name (Legal Business Name): KELLY GOULD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2026
Last Update Date: 10/03/2026
Certification Date: 10/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2304 RELIANCE CT
JARRETTSVILLE MD
21084-1015
US

IV. Provider business mailing address

2304 RELIANCE CT
JARRETTSVILLE MD
21084-1015
US

V. Phone/Fax

Practice location:
  • Phone: 443-928-9206
  • Fax:
Mailing address:
  • Phone: 443-928-9206
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License NumberA00227589
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: