Provider Demographics
NPI:1871521393
Name:JONES-FEARING, KIM (MD)
Entity type:Individual
Prefix:
First Name:KIM
Middle Name:
Last Name:JONES-FEARING
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11221 KINSALE CT
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042-6131
Mailing Address - Country:US
Mailing Address - Phone:410-419-3769
Mailing Address - Fax:
Practice Address - Street 1:11221 KINSALE CT
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21042-6131
Practice Address - Country:US
Practice Address - Phone:410-419-3769
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD461242084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC23320001OtherBC DC/METRO
MD655605OtherUNITED HEALTHCARE
MD145091300Medicaid
MD54807209OtherBC MD