Provider Demographics
NPI:1548391584
Name:KUMAR, KELLY C (ACNP)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:C
Last Name:KUMAR
Suffix:
Gender:F
Credentials:ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 CENTER DR.
Mailing Address - Street 2:BUILDING 10, ROOM 5-1408
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20892-0004
Mailing Address - Country:US
Mailing Address - Phone:301-435-2783
Mailing Address - Fax:
Practice Address - Street 1:10 CENTER DR BLDG 10
Practice Address - Street 2:BUILDING 10, ROOM 5-1408
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20892-2976
Practice Address - Country:US
Practice Address - Phone:301-435-2783
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2022-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN1003189363LA2100X
MDAC000794363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care