Healthcare Provider Details

I. General information

NPI: 1528934817
Provider Name (Legal Business Name): KRYSTAL PETERSON FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/14/2025
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 GOODEN AVE
DOVER DE
19904-4143
US

IV. Provider business mailing address

22303 DUPONT BLVD
GEORGETOWN DE
19947-2153
US

V. Phone/Fax

Practice location:
  • Phone: 302-678-9355
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberLG-0013541
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: