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General NPI Number Information
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NPI Number | 1982125779
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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 | 06/30/2017
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Last Update Date | 05/27/2025
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Provider Practice Location Address
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Address Line | 5401 BELAIR RD BSMT
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City | BALTIMORE
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State | MD
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Zip | 21206-4266
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Country | US
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Telephone | 667-303-3700
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Fax |
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Provider Business Mailing Address
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Address Line | 5401 BELAIR RD BSMT
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City | BALTIMORE
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State | MD
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Zip | 21206-4266
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Country | US
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Telephone | 667-303-3700
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Fax |
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Authorized Official
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Title or Position | CRNP
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Name | KELLY MARIE HEYWARD
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Credential |
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Telephone | 717-434-8264
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number |
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License Number State |
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