Provider Demographics
NPI:1528416476
Name:KIPLAGAT, JACKLINE (FNP-C)
Entity Type:Individual
Prefix:
First Name:JACKLINE
Middle Name:
Last Name:KIPLAGAT
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4201 NORTHVIEW DR
Mailing Address - Street 2:SUITE 410
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20716-2604
Mailing Address - Country:US
Mailing Address - Phone:202-681-9661
Mailing Address - Fax:
Practice Address - Street 1:4201 NORTHVIEW DR
Practice Address - Street 2:SUITE 410
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20716-2604
Practice Address - Country:US
Practice Address - Phone:202-681-9661
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-01
Last Update Date:2016-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR187947363LF0000X
DCRN1016841363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily