Individual provider · Type 1 NPI
Mary Kackley
Nurse Practitioner · Washington, DC
Practice location
5255 Loughboro Rd NW
Washington, DC 20016-2633
Fax (202) 537-4588
Mailing address
6201 Greenleigh Ave
Middle River, MD 21220-2004
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 0024180229 (VA) |
| Nurse Practitioner Primary | 363L00000X | NP1039064 (DC) |
Nurse Practitioner: (1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance wit…
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About NPI 1285241554
Mary Kackley's National Provider Identifier is 1285241554, issued on Sep 30, 2020. The primary taxonomy on file is Nurse Practitioner (363L00000X), and the practice location is in Washington, DC. The record was last updated on Jul 21, 2025.