Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | AC000662 | MD |
NPI | 1023031697 |
---|---|
Provider Name | Kari Pratt |
First Address | Frederick, MD 21702-4427 |
Second Address | Frederick, MD 21702-4427 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/07/2006 |
Last Update Date | 12/12/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
307535400 | (05) | FL |