Provider Demographics
NPI:1942620802
Name:KENT, THERESE RUSSELL (CRNP)
Entity Type:Individual
Prefix:
First Name:THERESE
Middle Name:RUSSELL
Last Name:KENT
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2613 N POTOMAC ST
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22207-1005
Mailing Address - Country:US
Mailing Address - Phone:703-237-2548
Mailing Address - Fax:
Practice Address - Street 1:10 CENTER DR
Practice Address - Street 2:ROOM 2C145
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20892-1662
Practice Address - Country:US
Practice Address - Phone:301-496-9320
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-18
Last Update Date:2014-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDAC000213363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care