Kanan Dominica Lucy Fernandes, CRNP

Primary specialty

Acute Care Nurse PractitionerTaxonomy code 363LA2100X

License

R164021 Issued in MD

Practice address

7600 Carroll Ave
Takoma Park, MD 20912-6367

Phone

(301) 891-7600

NPI assigned

Mar 21, 2011

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

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

{
    "created_epoch": "1300665600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1300665600000",
    "number": "1891094512",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13629 PALMETTO CIR",
            "city": "GERMANTOWN",
            "state": "MD",
            "postal_code": "208746234",
            "telephone_number": "301-528-2016"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7600 CARROLL AVE",
            "city": "TAKOMA PARK",
            "state": "MD",
            "postal_code": "209126367",
            "telephone_number": "301-891-7600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FERNANDES",
        "first_name": "KANAN",
        "middle_name": "DOMINICA LUCY",
        "credential": "CRNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-03-21",
        "last_updated": "2011-03-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "MD",
            "license": "R164021",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MARYLAND BOARD OF NURSING- CRNP LICENSE NUMBER",
            "identifier": "R164021",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jackelyn R Farrell, P.A.
• Maren Farris, MSED BCBA
• Oluwatosin Fashola
• Fayaz a. Shawl, MD, PA
• Gary Ross Fennel, PA-C
• Gorgonia Villalon Ferrer, MD
• Firstchoice Medical Services LLC
• Sarah J. Fisher
• Christine Fitzgerald
• Ernest J Fiyufe

• Acute Care Nurse Practitioner in Takoma Park, MD
• Providers in Takoma Park, MD by specialty
• Acute Care Nurse Practitioner in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 21, 2011; 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.