Provider Demographics
NPI:1811332307
Name:GORDY, KRISTEN LYNN (CRNP-PMH)
Entity type:Individual
Prefix:MS
First Name:KRISTEN
Middle Name:LYNN
Last Name:GORDY
Suffix:
Gender:F
Credentials:CRNP-PMH
Other - Prefix:MS
Other - First Name:KRISTEN
Other - Middle Name:
Other - Last Name:CARSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1978
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21802-1978
Mailing Address - Country:US
Mailing Address - Phone:410-749-1015
Mailing Address - Fax:410-749-0654
Practice Address - Street 1:1104 HEALTHWAY DR
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21804-4469
Practice Address - Country:US
Practice Address - Phone:410-219-5483
Practice Address - Fax:410-219-5486
Is Sole Proprietor?:No
Enumeration Date:2013-05-09
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR182529363LP0808X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD119591300Medicaid