Kiethlyn Gabat, CRNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

R202095 Issued in MD

Practice address

111 Ryan Dr
Rising Sun, MD 21911-1841

Phone

(410) 642-9172

NPI assigned

Nov 26, 2021

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in MD, DC2 enrollments

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 2

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

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.

• MNR Industries, LLC

  • Urgent Care Clinic/Center
  • Bowie, MD
  • NPI 1093130924

  DC

  Medicare reassignment NPD
• MNR Industries, LLC

  • Urgent Care Clinic/Center
  • Bel Air, MD
  • NPI 1457478703
  Medicare reassignment NPD
• Corazon-Panes Sanchez,LLC

  • Pediatrics Physician
  • Rising Sun, MD
  • NPI 1255156576
  NPD
• MNR Industries LLC

  • Urgent Care Clinic/Center
  • Mount Airy, MD
  • NPI 1073963146
  NPD
• MNR Industries LLC

  • Urgent Care Clinic/Center
  • Laurel, MD
  • NPI 1164827663
  NPD
• MNR Industries, LLC

  • Urgent Care Clinic/Center
  • Upper Marlboro, MD
  • NPI 1194195008
  NPD
• MNR Industries, LLC

  • Urgent Care Clinic/Center
  • Bel Air, MD
  • NPI 1649089418
  NPD
• Corazon-Panes Sanchez,LLC

  • Pediatrics Physician
  • Port Deposit, MD
  • NPI 1568418531
  NPD (past)
• Nardine Assaad, MD, LLC

  • Pediatrics Physician
  • Towson, MD
  • NPI 1154955862
  NPD (past)

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

{
    "created_epoch": "1637884800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1637884800000",
    "number": "1124785019",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 RYAN DR",
            "city": "RISING SUN",
            "state": "MD",
            "postal_code": "219111841"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 RYAN DR",
            "city": "RISING SUN",
            "state": "MD",
            "postal_code": "219111841",
            "telephone_number": "410-642-9172"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "111 Ryan Dr",
            "address_purpose": "LOCATION",
            "city": "Rising Sun",
            "state": "MD",
            "postal_code": "219111841",
            "country_code": "US",
            "telephone_number": "410-642-9172",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GABAT",
        "first_name": "KIETHLYN",
        "credential": "CRNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-11-26",
        "last_updated": "2021-11-26",
        "certification_date": "2021-11-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MD",
            "license": "R202095",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "G-130-469-095-025",
            "state": "MD"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://www.sanchezpediatrics.com/",
            "affiliation": "N",
            "endpointDescription": "website",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "website",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "website",
            "address_1": "111 Ryan Dr",
            "city": "Rising Sun",
            "state": "MD",
            "country_code": "US",
            "postal_code": "219111841",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Drayer Physical Therapy of Maryland LLC
• Endeavour Healthcare LLC
• Jodi Lenoir French, PSY.D.
• Amy Ilene Fulcher-Belt
• Rachel Fullam, OTR/L
• Marina Mangaoang Garcia, M.D.
• Lance Lee Gardner, P.T.
• Genesis
• Gold Star Audiology Clinic
• Dakotah Catherine Greif, DPT

• Family Nurse Practitioner in Rising Sun, MD
• Providers in Rising Sun, MD by specialty
• Family Nurse Practitioner in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 26, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.