Provider Demographics
NPI:1871550004
Name:KEMPFER, RAECHELLE LYNN (NP)
Entity type:Individual
Prefix:
First Name:RAECHELLE
Middle Name:LYNN
Last Name:KEMPFER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 DULANEY VALLEY RD
Mailing Address - Street 2:SUITE
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-2600
Mailing Address - Country:US
Mailing Address - Phone:410-296-3104
Mailing Address - Fax:
Practice Address - Street 1:901 DULANEY VALLEY ROAD SUITE 110
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-1867
Practice Address - Country:US
Practice Address - Phone:410-296-3104
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2016-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041313205363L00000X
MO2012004957363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK39789OtherMEDICARE PTAN
P12277Medicare UPIN