Healthcare Provider Details

I. General information

NPI: 1548797624
Provider Name (Legal Business Name): REGINA KITTERMAN KEEFE APRN-PMH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2017
Last Update Date: 05/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2911 OLNEY SANDY SPRING RD STE C
OLNEY MD
20832-3507
US

IV. Provider business mailing address

2911 OLNEY SANDY SPRING RD STE C
OLNEY MD
20832-3507
US

V. Phone/Fax

Practice location:
  • Phone: 301-466-9457
  • Fax:
Mailing address:
  • Phone: 301-466-9457
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License NumberR115535
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: