Healthcare Provider Details

I. General information

NPI: 1063298008
Provider Name (Legal Business Name): KHALANIS KURE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2023
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1718 BELMONT AVE STE D
WINDSOR MILL MD
21244-2552
US

IV. Provider business mailing address

1718 BELMONT AVE STE D
BALTIMORE MD
21244-2552
US

V. Phone/Fax

Practice location:
  • Phone: 617-943-0892
  • Fax:
Mailing address:
  • Phone: 443-257-4477
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: IMANI V BRYAN
Title or Position: NURSE PRACTITIONER
Credential: FNP, CRNP
Phone: 617-943-0892