Individual
KELLY LLEWELLYN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNP, FNP-BC
Contact information
Practice address
9093 RIDGEFIELD DR, #104, FREDERICK, MD 21701-6710
(301) 682-4100
(301) 682-9100
Mailing address
9115 SYCAMORE CT, UNION BRIDGE, MD 21791-7560
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R143168
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
926580505
—
MD
05
—
926580508
—
MD
Enumeration date
11/04/2013
Last updated
08/02/2016
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