Provider Demographics
NPI:1578139689
Name:KIBRET, BESERAT LEGESSE (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MISS
First Name:BESERAT
Middle Name:LEGESSE
Last Name:KIBRET
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14999 HEALTH CENTER DR STE 202
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20716-1079
Mailing Address - Country:US
Mailing Address - Phone:301-249-8100
Mailing Address - Fax:
Practice Address - Street 1:14999 HEALTH CENTER DR STE 202
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20716-1079
Practice Address - Country:US
Practice Address - Phone:301-249-8100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-29
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR203681363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty