Provider Demographics
NPI:1508892647
Name:FEELEY, NANCY KERN (ANP)
Entity Type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:KERN
Last Name:FEELEY
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:6201 GREENLEIGH AVE
Mailing Address - Street 2:
Mailing Address - City:MIDDLE RIVER
Mailing Address - State:MD
Mailing Address - Zip Code:21220-2004
Mailing Address - Country:US
Mailing Address - Phone:410-933-6423
Mailing Address - Fax:314-362-5470
Practice Address - Street 1:600 N WOLFE ST BLDG RM416
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21287-0005
Practice Address - Country:US
Practice Address - Phone:410-955-5268
Practice Address - Fax:410-367-2258
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2022-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017016496363L00000X
MDR095563363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO420048618Medicaid
MD298802000Medicaid
MDKR64428WMedicare ID - Type Unspecified