Doctor Name: | MS. AGNES JENNIFER KALLON |
NPI Number: | 1043536790 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | CRNP |
License Number: | R123473 |
Business Practice Address: | 7300 Hanover Dr Suite 301 Greenbelt, MD - 207702202 |
Business Phone Number: | 3013451800 |
Business Fax Number: | 3013453854 |
Mailing Address: | 9607 Oxbridge Way, BOWIE |
State: | MD |
Postal Code: | 207213035 |
Phone Number: | 2406919840 |
Fax Number: | |
NPI Enumeration Date: | 04/20/2010 |
NPI Last Update Date: | 10/14/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | R123473 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MD |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |