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General NPI Number Information
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NPI Number | 1487493367
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Entity Type | Organization
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Legal Business Name | KMH MEDICAL SERVICE LLC
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Dates
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Enumeration Date | 05/21/2024
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Last Update Date | 05/21/2024
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Provider Practice Location Address
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Address Line | 5401 BELAIR RD
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City | BALTIMORE
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State | MD
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Zip | 21206-4265
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Country | US
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Telephone | 717-577-2736
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Fax |
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Provider Business Mailing Address
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Address Line | 1637 COLD BOTTOM RD
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City | SPARKS GLENCOE
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State | MD
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Zip | 21152-9524
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Country | US
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Telephone | 717-577-2736
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MRS. KELLY HEYWARD
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Credential | CRNP
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Telephone | 717-577-2736
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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