Provider Demographics
NPI:1083152284
Name:PETTY, KABRIMA Y (DNP, APRN, NP-C)
Entity Type:Individual
Prefix:
First Name:KABRIMA
Middle Name:Y
Last Name:PETTY
Suffix:
Gender:F
Credentials:DNP, APRN, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4239 TALMADGE CIR
Mailing Address - Street 2:
Mailing Address - City:CAMP SPRINGS
Mailing Address - State:MD
Mailing Address - Zip Code:20746-4391
Mailing Address - Country:US
Mailing Address - Phone:202-741-2449
Mailing Address - Fax:
Practice Address - Street 1:10201 BALTIMORE AVE APT 5102
Practice Address - Street 2:
Practice Address - City:COLLEGE PARK
Practice Address - State:MD
Practice Address - Zip Code:20740
Practice Address - Country:US
Practice Address - Phone:202-537-1587
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-08
Last Update Date:2021-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN1026990363LF0000X
MDR227548363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily