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General NPI Number Information
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NPI Number | 1134129273
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Entity Type | Individual
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Provider Name | KRYSTAL LEIGH THOMAS CRNP
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Gender | Female
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Dates
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Enumeration Date | 07/29/2005
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Last Update Date | 08/10/2007
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Provider Practice Location Address
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Address Line | 501 DUTCHMANS LN
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City | EASTON
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State | MD
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Zip | 21601-3342
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Country | US
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Telephone | 410-822-8888
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Fax |
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Provider Business Mailing Address
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Address Line | 710 OBRECHT RD
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City | SYKESVILLE
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State | MD
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Zip | 21784-7650
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Country | US
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Telephone | 410-759-8808
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | R077623
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License Number State | MD
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