Provider Demographics
NPI:1851641955
Name:KAMARA, KELVINDA (FNP-BC, PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:KELVINDA
Middle Name:
Last Name:KAMARA
Suffix:
Gender:F
Credentials:FNP-BC, PMHNP-BC
Other - Prefix:
Other - First Name:NONE
Other - Middle Name:
Other - Last Name:NONE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CRNP
Mailing Address - Street 1:1002 CORTANA COURT
Mailing Address - Street 2:
Mailing Address - City:SEVERN
Mailing Address - State:MD
Mailing Address - Zip Code:21144-1184
Mailing Address - Country:US
Mailing Address - Phone:240-898-1810
Mailing Address - Fax:949-863-6460
Practice Address - Street 1:1002 CORTANA COURT
Practice Address - Street 2:
Practice Address - City:SEVERN
Practice Address - State:MD
Practice Address - Zip Code:21144-1184
Practice Address - Country:US
Practice Address - Phone:240-898-1810
Practice Address - Fax:240-493-8657
Is Sole Proprietor?:No
Enumeration Date:2012-09-16
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR174859363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD059076500Medicaid