Healthcare Provider Details

I. General information

NPI: 1518188614
Provider Name (Legal Business Name): MISTY LYNN KLINE RN, CCRN, MSN, ACNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 08/23/2023
Certification Date: 08/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 BUTLER AVE STE 413-B
MARTINSBURG WV
25405-9990
US

IV. Provider business mailing address

45 WEMPE DR
CUMBERLAND MD
21502-3705
US

V. Phone/Fax

Practice location:
  • Phone: 304-263-0811
  • Fax: 304-579-2673
Mailing address:
  • Phone: 301-876-0236
  • Fax: 304-579-2673

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberRN967986
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number0024167227
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number715923
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberR133350
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: