Provider Demographics
NPI:1497345367
Name:MCKELVIE, KATHRYN (CRNP)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:MCKELVIE
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1503 POTOMAC AVE
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21742-2930
Mailing Address - Country:US
Mailing Address - Phone:301-733-8515
Mailing Address - Fax:
Practice Address - Street 1:1503 POTOMAC AVE
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21742-2930
Practice Address - Country:US
Practice Address - Phone:301-733-8515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-24
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR210010363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily