MEDICARE: KELLIE NOELLE JAMES CRNP

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	363L00000X	Nurse Practitioner	0024187212	VA
2	363LA2200X	Adult Health Nurse Practitioner	53-75106-122	KS
3	363LA2200X	Adult Health Nurse Practitioner	SP023623	PA

General Provider Information

NPI Number	:	1700101862
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLIE NOELLE JAMES CRNP

Provider Business Mailing Address
First Line	:	PO BOX 37174
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21297-3174
Country	:	US
Telephone Number	:	571-423-5699
Fax Number	:	571-423-5698

Provider Business Practice Location Address
First Line	:	500 N WASHINGTON ST STE 300
Second Line	:
City	:	FALLS CHURCH
State	:	VA
Zip	:	22046-3514
Country	:	US
Telephone Number	:	571-419-5645
Fax Number	:	571-419-5641

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

Provider Enumeration Date	:	04/01/2010
Last Update Date	:	06/21/2023

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