Provider Demographics
NPI:1598264533
Name:KINNALLY, ASHLEY MORAN (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:MORAN
Last Name:KINNALLY
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:MS
Other - First Name:ASHLEY
Other - Middle Name:NICOLE
Other - Last Name:MORAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1658 ALBERMARLE DR
Mailing Address - Street 2:
Mailing Address - City:CROFTON
Mailing Address - State:MD
Mailing Address - Zip Code:21114-2001
Mailing Address - Country:US
Mailing Address - Phone:443-336-1474
Mailing Address - Fax:
Practice Address - Street 1:160 COURSEVALL DR
Practice Address - Street 2:
Practice Address - City:CENTREVILLE
Practice Address - State:MD
Practice Address - Zip Code:21617-1824
Practice Address - Country:US
Practice Address - Phone:443-262-4100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-05
Last Update Date:2018-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR191903163W00000X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No163W00000XNursing Service ProvidersRegistered Nurse