Provider Demographics
NPI:1033672076
Name:KEMP, DARRYL
Entity Type:Individual
Prefix:
First Name:DARRYL
Middle Name:
Last Name:KEMP
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:KEMP
Other - Middle Name:AND
Other - Last Name:ASSOCIATES ASSISTED LIVING I
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1430 REISTERSTOWN RD # C
Mailing Address - Street 2:
Mailing Address - City:PIKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-3843
Mailing Address - Country:US
Mailing Address - Phone:410-365-8625
Mailing Address - Fax:410-580-0616
Practice Address - Street 1:1311 N LUZERNE AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21213-3715
Practice Address - Country:US
Practice Address - Phone:410-365-8625
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-08
Last Update Date:2019-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD30AL3786-A172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker