Individual provider Active NPI

Deborah Carina Kelly-Williams, CRNP

  • Gerontology Nurse Practitioner
  • Washington, DC
National Provider Identifier
1093090284
Registry record updated May 7, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gerontology Nurse PractitionerTaxonomy code 363LG0600X
License
R144348 Issued in MD
Practice address
2425 25TH St SE
Washington, DC 20020-3409
Phone
(240) 432-3022
NPI assigned
Oct 19, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 7, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gerontology Nurse Practitioner 363LG0600X R144348 MD Primary

Addresses

Primary practice location

2425 25TH St SE
Washington, DC 20020-3409

Mailing address

9524 Twilight CT
Columbia, MD 21046-1954
Phone (301) 725-9732

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DC
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20111118000292 DC Practitioner - Nurse Practitioner 5294909784 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
340422NYMDLicensed Practical Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Patience First LLC CurrentSince Feb 11, 2012 Accepting new patients
Home Physicians Baltimore, PC Past Accepting new patients
Patience First LLC PastSince May 11, 2025 Accepting new patients
Park Avenue Medical Associates, P.C. PastSince Dec 4, 1999 Accepting new patients

Locations

1328 Southern Ave SE
Ste 205
Washington, DC 20032
Phone (202) 544-7744

2425 25th St SE
Washington, DC 20020
Phone (202) 678-0013

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1318982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1746576000000",
    "number": "1093090284",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9524 TWILIGHT CT",
            "city": "COLUMBIA",
            "state": "MD",
            "postal_code": "210461954",
            "telephone_number": "301-725-9732",
            "fax_number": "301-725-9732"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2425 25TH ST SE",
            "city": "WASHINGTON",
            "state": "DC",
            "postal_code": "200203409",
            "telephone_number": "240-432-3022"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY-WILLIAMS",
        "first_name": "DEBORAH",
        "middle_name": "CARINA",
        "name_prefix": "Mrs.",
        "credential": "CRNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-10-19",
        "last_updated": "2025-05-07",
        "certification_date": "2025-05-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "MD",
            "license": "R144348",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Washington, DC

Sources for this page

Verify at the official NPI Registry.