1124015300 NPI number — KRISTEN MILIO NELMS CRNP

Table of content: KRISTEN MILIO NELMS CRNP (NPI 1124015300)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124015300 NPI number — KRISTEN MILIO NELMS CRNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NELMS
Provider First Name:
KRISTEN
Provider Middle Name:
MILIO
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CRNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
COLUMBIA
Provider Other First Name:
KRISTEN
Provider Other Middle Name:
MILIO
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1124015300
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/12/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
301 HOSPITAL DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GLEN BURNIE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21061-5803
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-553-8300
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
301 HOSPITAL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GLEN BURNIE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21061-5803
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-553-8300
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/03/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X , with the licence number:  R152210 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: F591-0025 . This is a "CARE FIRST DC" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: 6784 . This is a "BRAVO HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 643255-02 . This is a "CARE FIRST MARYLAND RENDERING NUMBER" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 406267100 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com