Individual
MARY KACKLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5255 LOUGHBORO RD NW, WASHINGTON, DC 20016-2633
(202) 537-4000
(202) 537-4588
Mailing address
6201 GREENLEIGH AVE, MIDDLE RIVER, MD 21220-2004
(202) 537-4000
(410) 500-4266
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
NP1039064
DC
363LF0000X
Family Nurse Practitioner
0024180229
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0024180229
VIRGINIA BOARD OF NURSING
VA
Enumeration date
09/30/2020
Last updated
07/21/2025
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