Provider Demographics
NPI:1811476096
Name:BARTZ, KELLY (CRNP-PMH)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:BARTZ
Suffix:
Gender:F
Credentials:CRNP-PMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:811 RITCHIE HWY STE 15
Mailing Address - Street 2:
Mailing Address - City:SEVERNA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:21146-4130
Mailing Address - Country:US
Mailing Address - Phone:410-995-9993
Mailing Address - Fax:410-995-8702
Practice Address - Street 1:811 RITCHIE HWY STE 15
Practice Address - Street 2:
Practice Address - City:SEVERNA PARK
Practice Address - State:MD
Practice Address - Zip Code:21146-4130
Practice Address - Country:US
Practice Address - Phone:410-995-9993
Practice Address - Fax:410-995-8702
Is Sole Proprietor?:No
Enumeration Date:2018-08-09
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR189658363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health