Provider Demographics
NPI:1437273042
Name:KELLEY, PATRICIA ANN WATTS (PHD, RN, FNP, GNP)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:ANN WATTS
Last Name:KELLEY
Suffix:
Gender:F
Credentials:PHD, RN, FNP, GNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9208 COLUMBIA BLVD
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-1722
Mailing Address - Country:US
Mailing Address - Phone:301-587-8315
Mailing Address - Fax:
Practice Address - Street 1:NATIONAL NAVAL MEDICAL CTR
Practice Address - Street 2:8901 WISCONSIN AVE
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20889-0001
Practice Address - Country:US
Practice Address - Phone:240-603-4566
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA147206363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner