Provider Demographics
NPI:1962644211
Name:O'BRIEN, KEVIN JOHN (CRNP)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:JOHN
Last Name:O'BRIEN
Suffix:
Gender:M
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:NATIONAL INSTITUTES OF HEALTH 10 CENTER DRIVE
Mailing Address - Street 2:BLDG. 10 CRC RM 3-2551
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:28092-1205
Mailing Address - Country:US
Mailing Address - Phone:301-435-2824
Mailing Address - Fax:301-496-7157
Practice Address - Street 1:NATIONAL INSTITUTES OF HEALTH 10 CENTER DRIVE
Practice Address - Street 2:BLDG. 10 CRC RM 3-2551
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:28092-1205
Practice Address - Country:US
Practice Address - Phone:301-435-2824
Practice Address - Fax:301-496-7157
Is Sole Proprietor?:No
Enumeration Date:2009-04-01
Last Update Date:2009-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR115472363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD0320208OtherADULT NP CERTIFICATION NUMBER
MDR115472OtherRN LICENSE NUMBER