Healthcare Provider Details

I. General information

NPI: 1356533061
Provider Name (Legal Business Name): KRISTIN LYNN BUSSELL MS, CRNP-PMH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2007
Last Update Date: 04/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 SHORE VIEW CIR
CROWNSVILLE MD
21032-1250
US

IV. Provider business mailing address

7310 RITCHIE HWY SUITE 512
GLEN BURNIE MD
21061-3065
US

V. Phone/Fax

Practice location:
  • Phone: 240-988-6407
  • Fax:
Mailing address:
  • Phone: 410-761-7042
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR086841
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License NumberR086841
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: