Active NPI
Susan Kim, CRNP
- Pediatric Nurse Practitioner
- Eldersburg, MD
National Provider Identifier
1629466826
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Nurse Practitioner
- License
- R213300
- Practice address
- 1030 Liberty Rd
Suite 100
Eldersburg, MD 21784-7941 - Phone
- (410) 549-0900
- Fax
- (410) 549-6121
- NPI assigned
- Dec 23, 2014
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Nurse Practitioner | 363LP0200X | R213300 | MD | Primary |
Addresses
Primary practice location
1030 Liberty Rd
Suite 100
Eldersburg, MD 21784-7941
Mailing address
1030 Liberty Rd
Suite 100
Eldersburg, MD 21784-7941
Phone (410) 549-0900
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R213300 | MD | MD | Pediatric Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1419292800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1419292800000",
"number": "1629466826",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1030 LIBERTY RD",
"address_2": "SUITE 100",
"city": "ELDERSBURG",
"state": "MD",
"postal_code": "217847941",
"telephone_number": "410-549-0900",
"fax_number": "410-549-6121"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1030 LIBERTY RD",
"address_2": "SUITE 100",
"city": "ELDERSBURG",
"state": "MD",
"postal_code": "217847941",
"telephone_number": "410-549-0900",
"fax_number": "410-549-6121"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "SUSAN",
"name_prefix": "Mrs.",
"credential": "CRNP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-12-23",
"last_updated": "2014-12-23",
"status": "A"
},
"taxonomies": [
{
"code": "363LP0200X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Pediatrics",
"state": "MD",
"license": "R213300",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Eldersburg, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 23, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.