Healthcare Provider Details

I. General information

NPI: 1619845195
Provider Name (Legal Business Name): KERRY ERIN PINKHAM FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2025
Last Update Date: 10/27/2025
Certification Date: 10/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 CHARLES ST
LA PLATA MD
20646-5931
US

IV. Provider business mailing address

2830 WARRENTON RD
FREDERICKSBURG VA
22406-4600
US

V. Phone/Fax

Practice location:
  • Phone: 855-910-3278
  • Fax:
Mailing address:
  • Phone: 978-815-6835
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024195192
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: