Active NPI
Mark M Kelley, RNP
- Nurse Practitioner
- Elkridge, MD
National Provider Identifier
1003153750
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- P000562
- Practice address
- 6514 Meadowridge Rd
Elkridge, MD 21075-6115 - Phone
- (855) 247-8474
- NPI assigned
- Jan 14, 2013
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | P000562 | AR | Primary |
Addresses
Primary practice location
6514 Meadowridge Rd
Elkridge, MD 21075-6115
Mailing address
20330 John Rd
Little Rock, AR 72210-5509
Phone (501) 821-5815
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| P000562 | AR | MD | Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1358121600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1358121600000",
"number": "1003153750",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "20330 JOHN RD",
"city": "LITTLE ROCK",
"state": "AR",
"postal_code": "722105509",
"telephone_number": "501-821-5815"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6514 MEADOWRIDGE RD",
"city": "ELKRIDGE",
"state": "MD",
"postal_code": "210756115",
"telephone_number": "855-247-8474"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KELLEY",
"first_name": "MARK",
"middle_name": "M",
"name_prefix": "Mr.",
"credential": "RNP",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2013-01-14",
"last_updated": "2013-01-14",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "AR",
"license": "P000562",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Elkridge, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.