Individual
KELLY AMIKE NGENGE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
107 BIERSTADT CT, FREDERICK, MD 21702-6442
(512) 788-8867
Mailing address
107 BIERSTADT CT, FREDERICK, MD 21702-6442
(512) 788-8867
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
R226054
MD
Other
Enumeration date
08/18/2020
Last updated
09/22/2020
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