Healthcare Provider Details

I. General information

NPI: 1770060550
Provider Name (Legal Business Name): KATHRYN KYLE DAILEADER AGPCNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2018
Last Update Date: 07/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10110 MOLECULAR DR STE 206
ROCKVILLE MD
20850-7542
US

IV. Provider business mailing address

1946 RHODE ISLAND AVE
MC LEAN VA
22101-4918
US

V. Phone/Fax

Practice location:
  • Phone: 301-279-2779
  • Fax: 301-279-2767
Mailing address:
  • Phone: 703-283-7782
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAC002373
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: