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General NPI Number Information
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NPI Number | 1730771064
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Entity Type | Individual
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Provider Name | GAIL HENRI KELLY CRNP-FAMILY
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Gender | Female
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Dates
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Enumeration Date | 02/08/2021
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Last Update Date | 02/03/2025
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Provider Practice Location Address
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Address Line | 1102 E JOPPA RD
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City | TOWSON
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State | MD
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Zip | 21286-5805
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Country | US
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Telephone | 410-321-7210
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Fax |
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Provider Business Mailing Address
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Address Line | 13305 BEACH BLVD APT 1408
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City | JACKSONVILLE
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State | FL
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Zip | 32246-7348
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Country | US
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Telephone | 443-804-3245
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | R097105
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License Number State | MD
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