Provider Demographics
NPI:1083158042
Name:DERBYSHIRE, KRISTOPHER (CRNP)
Entity Type:Individual
Prefix:
First Name:KRISTOPHER
Middle Name:
Last Name:DERBYSHIRE
Suffix:
Gender:M
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6095 MARSHALEE DR
Mailing Address - Street 2:SUITE #100
Mailing Address - City:ELKRIDGE
Mailing Address - State:MD
Mailing Address - Zip Code:21075-6053
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6095 MARSHALEE DR
Practice Address - Street 2:UNITED HEALTH GROUP/OPTUM
Practice Address - City:ELKRIDGE
Practice Address - State:MD
Practice Address - Zip Code:21075-6053
Practice Address - Country:US
Practice Address - Phone:410-379-3599
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-10
Last Update Date:2016-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR200668363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care