NPIMap

Allegany College of Maryland

Organization Active NPI Family Nurse Practitioner · Cumberland, MD

NPI 1013463561 · NPPES record last updated Apr 28, 2017

Key facts

NPI
1013463561
Entity type
Organization (NPI type 2)
Primary specialty
Family Nurse Practitioner 363LF0000X
License
R081546 (MD)
Legal business name
ALLEGANY COLLEGE OF MARYLAND
Practice address
12401 Willowbrook Rd
Cumberland, MD 21502-2559
Phone
(301) 784-5670
Fax
(301) 784-5093
NPI assigned
Aug 25, 2016
Organization subpart
No

Authorized official

Name
Mrs. Anna Kephart
Title
Office Manager
Phone
(301) 784-5670

Corporate family (same tax ID) 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

National Provider Directory

Tax ID family
Allegany College of Maryland (2 organizations share this tax ID)

Locations

12401 Willowbrook Rd
Cumberland, MD 21502
Phone (301) 784-5540

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Medical Laboratory 291U00000X 21D2093034 MD
Family Nurse Practitioner
Group: 193400000X MULTIPLE SINGLE SPECIALTY GROUP		 363LF0000X R095433 MD
Family Nurse Practitioner
Group: 193400000X MULTIPLE SINGLE SPECIALTY GROUP		 363LF0000X R081546 MD Yes

Addresses

Primary practice location

12401 Willowbrook Rd
Cumberland, MD 21502-2559

Mailing address

12401 Willowbrook Rd
Cumberland, MD 21502-2559
Phone (301) 784-5670

Other names

  • Nurse Managed Wellness Clinic Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Apr 28, 2017.

{
    "created_epoch": "1472083200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1493337600000",
    "number": "1013463561",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12401 WILLOWBROOK RD",
            "city": "CUMBERLAND",
            "state": "MD",
            "postal_code": "215022559",
            "telephone_number": "301-784-5670",
            "fax_number": "301-784-5093"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12401 WILLOWBROOK RD",
            "city": "CUMBERLAND",
            "state": "MD",
            "postal_code": "215022559",
            "telephone_number": "301-784-5670",
            "fax_number": "301-784-5093"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALLEGANY COLLEGE OF MARYLAND",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-08-25",
        "last_updated": "2017-04-28",
        "status": "A",
        "authorized_official_last_name": "KEPHART",
        "authorized_official_first_name": "ANNA",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "301-784-5670",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "MD",
            "license": "21D2093034",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": "MD",
            "license": "R095433",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": "MD",
            "license": "R081546",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Nurse Managed Wellness Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Cumberland, MD

All providers in Cumberland, MD · Family Nurse Practitioner in Maryland

Sources for this page

Verify at the official NPI Registry.