Kelly Jo Peters, MSN, APRN-BC

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

R114413 Issued in MD

Practice address

610 9TH Ave
Brunswick, MD 21716-1828

Phone

(301) 834-7188

Fax

(301) 834-7889

NPI assigned

May 7, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science - Nursing

State licenses

Practice roles

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.

• Frederick Health Hospital Inc

  • General Acute Care Hospital
  • Frederick, MD
  • NPI 1538165527
  NPD (past)
• Walnut Street Community Health Center, Inc.

  • Federally Qualified Health Center (FQHC)
  • Hagerstown, MD
  • NPI 1366425266
  NPD (past)

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

{
    "created_epoch": "1178496000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1278028800000",
    "number": "1295948222",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "610 9TH AVE",
            "city": "BRUNSWICK",
            "state": "MD",
            "postal_code": "217161828",
            "telephone_number": "301-834-7188",
            "fax_number": "301-834-6350"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "610 9TH AVE",
            "city": "BRUNSWICK",
            "state": "MD",
            "postal_code": "217161828",
            "telephone_number": "301-834-7188",
            "fax_number": "301-834-7889"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERS",
        "first_name": "KELLY",
        "middle_name": "JO",
        "credential": "MSN, APRN-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-05-07",
        "last_updated": "2010-07-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MD",
            "license": "R114413",
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "WV",
            "license": "49577",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Pain & Strength Mobile PT, LLC
• Marwin Pascua
• Passion Nursing Care Services, LLC
• Paul H Heavner
• Andrea Peters, RN
• Robert Phillips
• Privia Medical Group, LLC
• Geri Pryor, CAS
• Karen E Ramirez
• S Hollingsworth LLC

• All providers in Brunswick, MD
• Family Nurse Practitioner in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 2, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.