Provider Demographics
NPI:1043342603
Name:STORM, KATHLEEN A (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:A
Last Name:STORM
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12510 OCEAN GTWY
Mailing Address - Street 2:
Mailing Address - City:OCEAN CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21842-9690
Mailing Address - Country:US
Mailing Address - Phone:410-213-1228
Mailing Address - Fax:
Practice Address - Street 1:12510 OCEAN GTWY
Practice Address - Street 2:
Practice Address - City:OCEAN CITY
Practice Address - State:MD
Practice Address - Zip Code:21842-9690
Practice Address - Country:US
Practice Address - Phone:410-213-1228
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2014-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR064798363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDS1270006OtherCAREFIRST REGIONAL GBMC
MD264842OtherGBMC KAISER PERM
MDKJ73-89370001OtherCAREFIRST OF MARYLAND GBM