Provider Demographics
NPI:1194392001
Name:NURSE PRACTITIONER ON CALL LLC
Entity Type:Organization
Organization Name:NURSE PRACTITIONER ON CALL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:KELVINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:KAMARA
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP
Authorized Official - Phone:240-898-1810
Mailing Address - Street 1:1002 CORTANA CT
Mailing Address - Street 2:
Mailing Address - City:SEVERN
Mailing Address - State:MD
Mailing Address - Zip Code:21144-1184
Mailing Address - Country:US
Mailing Address - Phone:240-898-1810
Mailing Address - Fax:240-493-8657
Practice Address - Street 1:1800 N CHARLES ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-5920
Practice Address - Country:US
Practice Address - Phone:240-898-1810
Practice Address - Fax:240-493-8657
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NURSE PRACTITIONER ON CALL, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-06-09
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD059076500Medicaid