Provider Demographics
NPI:1669240065
Name:CARRERA PENA, KATHERINE (DNP)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:CARRERA PENA
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14955 SHADY GROVE RD STE 380
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-8717
Mailing Address - Country:US
Mailing Address - Phone:301-424-6181
Mailing Address - Fax:301-424-0834
Practice Address - Street 1:14955 SHADY GROVE RD STE 380
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-8717
Practice Address - Country:US
Practice Address - Phone:301-424-6181
Practice Address - Fax:301-424-0834
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-14
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR262421363LP2300X, 363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care