Provider Demographics
NPI:1376235499
Name:MCKISSICK, SUMMER NICHOLE (A-GNP-C)
Entity type:Individual
Prefix:
First Name:SUMMER
Middle Name:NICHOLE
Last Name:MCKISSICK
Suffix:
Gender:F
Credentials:A-GNP-C
Other - Prefix:
Other - First Name:SUMMER
Other - Middle Name:NICHOLE
Other - Last Name:WALTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:532 BALTIMORE BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:MD
Mailing Address - Zip Code:21157-6118
Mailing Address - Country:US
Mailing Address - Phone:667-367-2778
Mailing Address - Fax:443-341-3432
Practice Address - Street 1:532 BALTIMORE BLVD STE 101
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157-6118
Practice Address - Country:US
Practice Address - Phone:667-367-2778
Practice Address - Fax:443-341-3432
Is Sole Proprietor?:No
Enumeration Date:2023-05-25
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR24395363LA2200X
MDAG05230043363LG0600X, 363LP2300X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care