MEDICARE: MS. MARY ANN KEARLEY A.P.R.N.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	0701001342	VA
2	364SC1501X	Community Health/Public Health Clinical Nurse Specialist	0015000183	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1215002290
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARY ANN KEARLEY A.P.R.N.

Provider Business Mailing Address
First Line	:	6465 COLLEGE PARK SQ
Second Line	:	SUITE 210
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23464-3609
Country	:	US
Telephone Number	:	757-420-0530
Fax Number	:	757-420-0488

Provider Business Practice Location Address
First Line	:	6465 COLLEGE PARK SQ
Second Line	:	SUITE 210
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23464-3609
Country	:	US
Telephone Number	:	757-420-0530
Fax Number	:	757-420-0488

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/22/2006
Last Update Date	:	02/09/2015

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