Allegany College of Maryland

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

R095433 Issued in MD

Legal business name

ALLEGANY COLLEGE OF MARYLAND

Doing business as

Nurse Managed Wellness Clinic LAB

Practice address

12401 Willowbrook Rd
Allied Health Building, Room 115
Cumberland, MD 21502-2559

Phone

(301) 784-5670

Fax

(301) 784-5093

NPI assigned

Nov 8, 2016

Last updated

Apr 18, 2017By the provider in NPPES

Organization subpart

Yes

Parent organization

ALLEGANY COLLEGE OF MARYLAND NURSE MANAGED WELLNESS CLINICAs reported in NPPES

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

Authorized official

Name

Mrs. Anna M Kephart

Title

Office Manager

Phone

(301) 784-5670

Specialties & licenses 2

Addresses

Other names 1

• Nurse Managed Wellness Clinic LAB Doing business as

Tax ID family

Allegany College of Maryland2 organizations share this tax ID, including this one

Part of

Allegany College of Maryland

Other organizations with this tax ID 1

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

• Allegany College of Maryland

  dba Nurse Managed Wellness Clinic

  • Family Nurse Practitioner
  • Cumberland, MD
  • NPI 1013463561
  NPD tax ID

Locations

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

{
    "created_epoch": "1478563200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1492473600000",
    "number": "1427590488",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12401 WILLOWBROOK RD",
            "address_2": "ALLIED HEALTH BUILDING, ROOM 115",
            "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",
            "address_2": "ALLIED HEALTH BUILDING, ROOM 115",
            "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": "YES",
        "parent_organization_legal_business_name": "ALLEGANY COLLEGE OF MARYLAND NURSE MANAGED WELLNESS CLINIC",
        "enumeration_date": "2016-11-08",
        "last_updated": "2017-04-18",
        "status": "A",
        "authorized_official_last_name": "KEPHART",
        "authorized_official_first_name": "ANNA",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "301-784-5670",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MD",
            "license": "R081546",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MD",
            "license": "R095433",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Nurse Managed Wellness Clinic LAB",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Matthew James Allaway, DO
• Allegany Allergy and Asthma (Jeremy M Drelich)
• Allegany Ambulatory Surgery Center LLC
• Allegany Behavioral Medicine
• Allegany College of Maryland (Nurse Managed Wellness Clinic)
• Allegany County Commissioners (Allegany County Nursing Home)
• Allegany County County Commissioners
• Allegany County Day Care Center
• Allegany County Health Department
• Allegany County Health Department

• Family Nurse Practitioner in Cumberland, MD
• Providers in Cumberland, 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 Apr 18, 2017; 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.