Provider Demographics
NPI:1154636785
Name:JALLOH, KADIE BALLAH (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:KADIE
Middle Name:BALLAH
Last Name:JALLOH
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 1:13201 5TH ST
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20720-3609
Mailing Address - Country:US
Mailing Address - Phone:301-809-0545
Mailing Address - Fax:
Practice Address - Street 1:13201 5TH ST
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20720-3609
Practice Address - Country:US
Practice Address - Phone:301-809-0545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-06
Last Update Date:2010-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR128225363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily