Healthcare Provider Details

I. General information

NPI: 1225736994
Provider Name (Legal Business Name): KELLY GRAY NELSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2023
Last Update Date: 02/05/2025
Certification Date: 02/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15001 SHADY GROVE RD STE 300
ROCKVILLE MD
20850-6353
US

IV. Provider business mailing address

326 BRYANT ST NE
WASHINGTON DC
20002-1122
US

V. Phone/Fax

Practice location:
  • Phone: 301-340-3252
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberRN1050302
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberR264452
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: