Provider Demographics
NPI:1053644062
Name:DAVIS, KYLEEN ERIN (RN, FNP)
Entity Type:Individual
Prefix:
First Name:KYLEEN
Middle Name:ERIN
Last Name:DAVIS
Suffix:
Gender:F
Credentials:RN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5530 WISCONSIN AVE STE 820
Mailing Address - Street 2:
Mailing Address - City:CHEVY CHASE
Mailing Address - State:MD
Mailing Address - Zip Code:20815-4401
Mailing Address - Country:US
Mailing Address - Phone:301-652-8081
Mailing Address - Fax:301-652-8627
Practice Address - Street 1:5530 WISCONSIN AVE STE 820
Practice Address - Street 2:
Practice Address - City:CHEVY CHASE
Practice Address - State:MD
Practice Address - Zip Code:20815-4401
Practice Address - Country:US
Practice Address - Phone:301-652-8081
Practice Address - Fax:301-652-8627
Is Sole Proprietor?:No
Enumeration Date:2009-09-09
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN1010471363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC166991YT2Medicare PIN