Healthcare Provider Details

I. General information

NPI: 1245287788
Provider Name (Legal Business Name): KIMBERLY KARLI CUOMO ANP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KIMBERLY JO KARLI ANP-C

II. Dates (important events)

Enumeration Date: 05/30/2006
Last Update Date: 06/27/2023
Certification Date: 06/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10755 FALLS RD
LUTHERVILLE MD
21093-4515
US

IV. Provider business mailing address

6201 GREENLEIGH AVE
MIDDLE RIVER MD
21220-2004
US

V. Phone/Fax

Practice location:
  • Phone: 410-583-2740
  • Fax:
Mailing address:
  • Phone: 410-933-6423
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR169391
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5003248
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: