Provider Demographics
NPI:1366120495
Name:KADDIE KALLON NURSING, LLC
Entity type:Organization
Organization Name:KADDIE KALLON NURSING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KADDIE
Authorized Official - Middle Name:
Authorized Official - Last Name:KALLON
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:240-899-2928
Mailing Address - Street 1:1503 EVARTS ST NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20018-2017
Mailing Address - Country:US
Mailing Address - Phone:240-899-2928
Mailing Address - Fax:240-451-1080
Practice Address - Street 1:1503 EVARTS ST NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20018-2017
Practice Address - Country:US
Practice Address - Phone:240-899-2928
Practice Address - Fax:240-451-1080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-10
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1427519404OtherNPI