Provider Demographics
NPI:1053920835
Name:ARGUERO, KELLY ROTH (RN)
Entity type:Individual
Prefix:MS
First Name:KELLY
Middle Name:ROTH
Last Name:ARGUERO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1820 TUCKER LN
Mailing Address - Street 2:
Mailing Address - City:ASHTON
Mailing Address - State:MD
Mailing Address - Zip Code:20861-9707
Mailing Address - Country:US
Mailing Address - Phone:240-678-9247
Mailing Address - Fax:
Practice Address - Street 1:2800 KIRK AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21218-3647
Practice Address - Country:US
Practice Address - Phone:410-467-7140
Practice Address - Fax:410-467-7141
Is Sole Proprietor?:No
Enumeration Date:2020-07-28
Last Update Date:2020-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR219919163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse