Individual
MARTHA SUZANNE KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
909 RIDGEBROOK RD STE 300, SPARKS, MD 21152-9477
(441) 383-9300
Mailing address
909 RIDGEBROOK RD STE 300, SPARKS, MD 21152-9477
(441) 383-9300
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN.397302
OH
363LF0000X
Family Nurse Practitioner
Primary
APRN.CNP.0027774
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
164W00000X
—
OH
Enumeration date
09/17/2012
Last updated
08/22/2025
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