Provider Demographics
NPI:1245287788
Name:CUOMO, KIMBERLY KARLI (ANP-C)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:KARLI
Last Name:CUOMO
Suffix:
Gender:F
Credentials:ANP-C
Other - Prefix:MISS
Other - First Name:KIMBERLY
Other - Middle Name:JO
Other - Last Name:KARLI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ANP-C
Mailing Address - Street 1:6201 GREENLEIGH AVE
Mailing Address - Street 2:
Mailing Address - City:MIDDLE RIVER
Mailing Address - State:MD
Mailing Address - Zip Code:21220-2004
Mailing Address - Country:US
Mailing Address - Phone:410-933-6423
Mailing Address - Fax:
Practice Address - Street 1:10755 FALLS RD
Practice Address - Street 2:
Practice Address - City:LUTHERVILLE
Practice Address - State:MD
Practice Address - Zip Code:21093-4515
Practice Address - Country:US
Practice Address - Phone:410-583-2740
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR169391363L00000X
NC5003248363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCNC6193AMedicare PIN
NC2594805Medicare PIN
MDQ67373Medicare UPIN