Provider Demographics
NPI:1497228159
Name:LOUGHRAN, KELLIE (NP)
Entity Type:Individual
Prefix:
First Name:KELLIE
Middle Name:
Last Name:LOUGHRAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:KELLIE
Other - Middle Name:
Other - Last Name:KAPLAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4910 MASSACHUSETTS AVE NW STE 114
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20016-4384
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4910 MASSACHUSETTS AVE NW STE 114
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20016-4384
Practice Address - Country:US
Practice Address - Phone:202-244-0812
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-05
Last Update Date:2019-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN1031079163W00000X, 363LF0000X
VA0024177002363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner