Provider Demographics
NPI:1285217638
Name:DONNELLY, KRISTEN MARY (PA-C, MPAS, MPH)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:MARY
Last Name:DONNELLY
Suffix:
Gender:F
Credentials:PA-C, MPAS, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10401 HOSPITAL DR STE 101
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MD
Mailing Address - Zip Code:20735-3150
Mailing Address - Country:US
Mailing Address - Phone:301-856-2323
Mailing Address - Fax:855-385-5335
Practice Address - Street 1:10401 HOSPITAL DR STE 101
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MD
Practice Address - Zip Code:20735-3150
Practice Address - Country:US
Practice Address - Phone:301-856-2323
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-04
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0008017363A00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant