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Individual

KATHRYN JANICE HEACOCK

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
DNP, APRN-CNS, CRNP

Contact information

Practice address
22 S GREENE ST, BALTIMORE, MD 21201-1590
(410) 328-4622
Mailing address
1035 NABBS CREEK RD, GLEN BURNIE, MD 21060-8435
(919) 593-4201

Taxonomy

Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
R226946
MD
364SA2100X
Acute Care Clinical Nurse Specialist
Primary
CS00199
MD

Other

Enumeration date
01/26/2023
Last updated
08/21/2023
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