Provider Demographics
NPI:1295345254
Name:CALLEY, KRISTIN COLLEEN (FNP)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:COLLEEN
Last Name:CALLEY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6675 BUSINESS PKWY STE F
Mailing Address - Street 2:
Mailing Address - City:ELKRIDGE
Mailing Address - State:MD
Mailing Address - Zip Code:21075-6349
Mailing Address - Country:US
Mailing Address - Phone:585-315-5494
Mailing Address - Fax:
Practice Address - Street 1:6675 BUSINESS PKWY STE F
Practice Address - Street 2:
Practice Address - City:ELKRIDGE
Practice Address - State:MD
Practice Address - Zip Code:21075-6349
Practice Address - Country:US
Practice Address - Phone:585-315-5494
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-05
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF345910363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily