Provider Demographics
NPI:1790037398
Name:CROSBY, KATHRYN GAIL (CRNP-PMH)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:GAIL
Last Name:CROSBY
Suffix:
Gender:F
Credentials:CRNP-PMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 W MADISON ST STE 11
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-2313
Mailing Address - Country:US
Mailing Address - Phone:443-438-7863
Mailing Address - Fax:443-957-9485
Practice Address - Street 1:10 E BALTIMORE ST STE 1400
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21202
Practice Address - Country:US
Practice Address - Phone:443-438-7863
Practice Address - Fax:443-957-9485
Is Sole Proprietor?:No
Enumeration Date:2012-10-05
Last Update Date:2019-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR147861163WP0809X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDLM49EAOtherCAREFIRST BCBS/MARYLAND
MDR968OtherCAREFIRST FEDERAL
MD609550002Medicaid
MD609550001Medicaid
MD522156095OtherCOMMERCIAL INSURANCE