Kelly Ettari

Primary specialty

Physician AssistantTaxonomy code 363A00000X

Practice address

9000 Franklin Square Dr
Baltimore, MD 21237-3901

Phone

(443) 777-7000

NPI assigned

Dec 18, 2023

Last updated

Jan 31, 2024By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

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

Physician Assistant

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Medstar Medical Group II LLC

  • General Practice Physician
  • Baltimore, MD
  • NPI 1184046187

  DC

  Medicare reassignment NPD
• WHC Physician Group LLC

  • General Practice Physician
  • Washington, DC
  • NPI 1700154226

  MD

  Medicare reassignment
• Medstar Medical Group II LLC

  • Internal Medicine Physician
  • Washington, DC
  • NPI 1376887844
  NPD
• Medstar Medical Group II LLC

  dba MMG Emergency Medicine Cfnrg

  • Emergency Medical Services (Emergency Medicine) Physician
  • Washington, DC
  • NPI 1558189712
  NPD
• WHC Emerg Phys

  • Emergency Medical Services (Emergency Medicine) Physician
  • Washington, DC
  • NPI 1306260625
  NPD

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

{
    "created_epoch": "1702857600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1706659200000",
    "number": "1386412542",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9000 FRANKLIN SQUARE DR",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212373901"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9000 FRANKLIN SQUARE DR",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212373901",
            "telephone_number": "443-777-7000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ETTARI",
        "first_name": "KELLY",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-12-18",
        "last_updated": "2024-01-31",
        "certification_date": "2024-01-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mary-Ann Adiaha-Obong Etiebet, MD
• Etienne T. Ngoumgna
• Kedar Shynick Etienne
• Rochelle Thilly Etienne, PA-C
• Ashley Ettah
• Jonathan Etter, M.D.
• Olanrewaju W Etti
• Derek Etube, PHARM.D
• Noelle Dare Etube, PHARMD
• Ogechi W Etuh

• Physician Assistant in Baltimore, MD
• Providers in Baltimore, MD by specialty
• Physician Assistant in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2024; 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.