Healthcare Provider Details

I. General information

NPI: 1447390331
Provider Name (Legal Business Name): KRISTA J. TOLBERT KLINE CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2007
Last Update Date: 01/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 N WOLFE ST
BALTIMORE MD
21287-0001
US

IV. Provider business mailing address

801 GARDENIA RD
SEVERNA PARK MD
21146-1236
US

V. Phone/Fax

Practice location:
  • Phone: 410-955-5829
  • Fax:
Mailing address:
  • Phone: 410-975-5177
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberR151700
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: