Provider Demographics
NPI:1497428569
Name:KIM, TAMARA KELLER (DNP, CPNP-PC)
Entity Type:Individual
Prefix:DR
First Name:TAMARA
Middle Name:KELLER
Last Name:KIM
Suffix:
Gender:F
Credentials:DNP, CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 DEVON DR
Mailing Address - Street 2:
Mailing Address - City:CHESTERTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21620-3366
Mailing Address - Country:US
Mailing Address - Phone:410-591-5828
Mailing Address - Fax:
Practice Address - Street 1:303 DEVON DR
Practice Address - Street 2:
Practice Address - City:CHESTERTOWN
Practice Address - State:MD
Practice Address - Zip Code:21620-3366
Practice Address - Country:US
Practice Address - Phone:410-591-5828
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-26
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR157873208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty