Provider Demographics
NPI:1104981224
Name:DUFFEY, KRISTY O'DELL (NP)
Entity type:Individual
Prefix:
First Name:KRISTY
Middle Name:O'DELL
Last Name:DUFFEY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8906 WINGED FOOT DR
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:MD
Mailing Address - Zip Code:21122-6670
Mailing Address - Country:US
Mailing Address - Phone:410-360-5140
Mailing Address - Fax:410-379-3591
Practice Address - Street 1:6085 MARSHALEE DR
Practice Address - Street 2:
Practice Address - City:ELKRIDGE
Practice Address - State:MD
Practice Address - Zip Code:21075-6023
Practice Address - Country:US
Practice Address - Phone:410-379-3528
Practice Address - Fax:410-379-3591
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR128753363LG0600X
DELD-0000115363LG0600X
DCRN1006277363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology