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Individual

JIE KONG

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
CRNP MSN

Contact information

Practice address
10802 HICKORY RIDGE RD, COLUMBIA, MD 21044-3622
(410) 997-1336
(410) 997-1636
Mailing address
10802 HICKORY RIDGE RD, COLUMBIA, MD 21044-3622
(410) 997-1336
(410) 997-1636

Taxonomy

Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R143501
MD

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
038278500
DC
01
1013404
COVENTRY
MD
01
1013404
FIRST HEALTH
VA
05
1215040951
MD
01
293176
KAISER
MD
05
411436100
MD
01
5707
ELDERHEALTH
MD
01
783571
NATIONAL CAPITAL PPO
MD
01
90192801
BLUE CROSS OF MARYLAND
MD
01
N1510003
BLUE CROSS FEDERAL
MD
Enumeration date
08/16/2006
Last updated
01/26/2017
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