Provider Demographics
NPI:1013536960
Name:KELI, PHILOMENA NUFUNKUEN (FNP)
Entity Type:Individual
Prefix:
First Name:PHILOMENA
Middle Name:NUFUNKUEN
Last Name:KELI
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2415 MUSGROVE RD STE 308
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-5223
Mailing Address - Country:US
Mailing Address - Phone:301-281-9083
Mailing Address - Fax:301-281-2268
Practice Address - Street 1:2415 MUSGROVE RD STE 308
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-5223
Practice Address - Country:US
Practice Address - Phone:301-281-9083
Practice Address - Fax:301-281-2268
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-10
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR193082261QP2300X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care