Healthcare Provider Details

I. General information

NPI: 1790037398
Provider Name (Legal Business Name): KATHRYN GAIL CROSBY CRNP-PMH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2012
Last Update Date: 10/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 E BALTIMORE ST STE 1400
BALTIMORE MD
21202
US

IV. Provider business mailing address

10 W MADISON ST STE 11
BALTIMORE MD
21201-2313
US

V. Phone/Fax

Practice location:
  • Phone: 443-438-7863
  • Fax: 443-957-9485
Mailing address:
  • Phone: 443-438-7863
  • Fax: 443-957-9485

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberR147861
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR147861
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: