Provider Demographics
NPI:1912909318
Name:OGLE, KATHLEEN T (CRNP)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:T
Last Name:OGLE
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1111 BENFIELD BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MILLERSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21108-3002
Mailing Address - Country:US
Mailing Address - Phone:410-729-5100
Mailing Address - Fax:410-729-5156
Practice Address - Street 1:1509 RITCHIE HWY
Practice Address - Street 2:
Practice Address - City:ARNOLD
Practice Address - State:MD
Practice Address - Zip Code:21012-2742
Practice Address - Country:US
Practice Address - Phone:410-757-7600
Practice Address - Fax:410-626-8043
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2011-01-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDR056115363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD7560021OtherAETNA PPO
MD1995999OtherAETNA HMO
MD545311-01OtherCAREFIRST MD RENDERING
MD120234OtherJHHC PROVIDER NUMBER
MD500005909OtherRAILROAD MEDICARE
MD7605-0022OtherCAREFIRST BLUECHOICE
MD076400100Medicaid
S73516Medicare UPIN
MD226L767XMedicare PIN