Healthcare Provider Details

I. General information

NPI: 1164040200
Provider Name (Legal Business Name): SRKITE ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2020
Last Update Date: 11/11/2020
Certification Date: 11/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 SUDBROOK LN STE 1A
PIKESVILLE MD
21208-4132
US

IV. Provider business mailing address

9532 BRANCHLEIGH RD
RANDALLSTOWN MD
21133-2000
US

V. Phone/Fax

Practice location:
  • Phone: 443-405-2564
  • Fax:
Mailing address:
  • Phone: 443-204-2421
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MS. SAMANTHA ROBERTA KITE
Title or Position: OWNER
Credential: NP
Phone: 443-204-2421