Provider Demographics
NPI:1912485244
Name:GOLDSBOROUGH, KELLI HILL (FNP-C)
Entity Type:Individual
Prefix:
First Name:KELLI
Middle Name:HILL
Last Name:GOLDSBOROUGH
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 N LA PLATA CT
Mailing Address - Street 2:
Mailing Address - City:LA PLATA
Mailing Address - State:MD
Mailing Address - Zip Code:20646-5207
Mailing Address - Country:US
Mailing Address - Phone:301-609-5044
Mailing Address - Fax:
Practice Address - Street 1:5 N LA PLATA CT STE 101
Practice Address - Street 2:
Practice Address - City:LA PLATA
Practice Address - State:MD
Practice Address - Zip Code:20646
Practice Address - Country:US
Practice Address - Phone:301-609-5044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-30
Last Update Date:2021-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR165295163WW0000X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No163WW0000XNursing Service ProvidersRegistered NurseWound Care