Provider Demographics
NPI:1699771428
Name:BROWN, KRISTA (CRNP)
Entity type:Individual
Prefix:MRS
First Name:KRISTA
Middle Name:
Last Name:BROWN
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:PO BOX 64380
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-4380
Mailing Address - Country:US
Mailing Address - Phone:410-328-6792
Mailing Address - Fax:410-328-8726
Practice Address - Street 1:29 S PACA ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1771
Practice Address - Country:US
Practice Address - Phone:410-328-6792
Practice Address - Fax:410-328-8726
Is Sole Proprietor?:No
Enumeration Date:2005-06-27
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP008493363LA2200X
MDR146338363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD4101201-00Medicaid
MD882775-01OtherBC/BS
Q41115Medicare UPIN
MDN668Medicare PIN