Provider Demographics
NPI:1134129273
Name:THOMAS, KRYSTAL LEIGH (CRNP)
Entity Type:Individual
Prefix:
First Name:KRYSTAL
Middle Name:LEIGH
Last Name:THOMAS
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 OBRECHT RD
Mailing Address - Street 2:
Mailing Address - City:SYKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21784-7650
Mailing Address - Country:US
Mailing Address - Phone:410-759-8808
Mailing Address - Fax:
Practice Address - Street 1:501 DUTCHMANS LN
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:MD
Practice Address - Zip Code:21601-3342
Practice Address - Country:US
Practice Address - Phone:410-822-8888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2007-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR077623363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q35168Medicare UPIN
S238K532Medicare ID - Type Unspecified