Provider Demographics
NPI:1376235499
Name:MCKISSICK, SUMMER NICHOLE (A-GNP-C)
Entity Type:Individual
Prefix:
First Name:SUMMER
Middle Name:NICHOLE
Last Name:MCKISSICK
Suffix:
Gender:F
Credentials:A-GNP-C
Other - Prefix:
Other - First Name:SUMMER
Other - Middle Name:NICHOLE
Other - Last Name:WALTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1815 FAWN WAY
Mailing Address - Street 2:
Mailing Address - City:FINKSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:21048-2020
Mailing Address - Country:US
Mailing Address - Phone:717-654-5164
Mailing Address - Fax:
Practice Address - Street 1:1815 FAWN WAY
Practice Address - Street 2:
Practice Address - City:FINKSBURG
Practice Address - State:MD
Practice Address - Zip Code:21048-2020
Practice Address - Country:US
Practice Address - Phone:717-654-5164
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-25
Last Update Date:2023-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR24395363LA2200X
MDAG05230043363LG0600X, 363LP2300X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care