Healthcare Provider Details

I. General information

NPI: 1851793616
Provider Name (Legal Business Name): KARA KELLY NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2014
Last Update Date: 10/30/2024
Certification Date: 10/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14800 PHYSICIANS LN STE 231
ROCKVILLE MD
20850-3948
US

IV. Provider business mailing address

9503 BURGEE PL
FREDERICK MD
21704-7842
US

V. Phone/Fax

Practice location:
  • Phone: 301-762-6686
  • Fax: 301-762-6646
Mailing address:
  • Phone: 240-559-8786
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR205420
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR205420
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code202D00000X
TaxonomyIntegrative Medicine Physician
License NumberR205420
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: