Provider Demographics
NPI:1215040951
Name:KONG, JIE (CRNP MSN)
Entity Type:Individual
Prefix:
First Name:JIE
Middle Name:
Last Name:KONG
Suffix:
Gender:F
Credentials:CRNP MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10802 HICKORY RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-3622
Mailing Address - Country:US
Mailing Address - Phone:410-997-1336
Mailing Address - Fax:410-997-1636
Practice Address - Street 1:10802 HICKORY RIDGE RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-3622
Practice Address - Country:US
Practice Address - Phone:410-997-1336
Practice Address - Fax:410-997-1636
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2017-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR143501363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD5707OtherELDERHEALTH
DC038278500Medicaid
MD783571OtherNATIONAL CAPITAL PPO
MD90192801OtherBLUE CROSS OF MARYLAND
MD293176OtherKAISER
MD1013404OtherCOVENTRY
MD1215040951Medicaid
MDN1510003OtherBLUE CROSS FEDERAL
VA1013404OtherFIRST HEALTH
MD411436100Medicaid
MD783571OtherNATIONAL CAPITAL PPO
MDQ74111Medicare UPIN
MD020357174Medicare PIN