Provider Demographics
NPI:1962491027
Name:DIAMOND, KATHLEEN CHESLEY (CRNP)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:CHESLEY
Last Name:DIAMOND
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 1:1906 BILLY BARTON CIR
Mailing Address - Street 2:
Mailing Address - City:REISTERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21136-5703
Mailing Address - Country:US
Mailing Address - Phone:410-561-1428
Mailing Address - Fax:
Practice Address - Street 1:3601 ODONNELL ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21224-5238
Practice Address - Country:US
Practice Address - Phone:410-864-4500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-20
Last Update Date:2011-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDRO88852363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily