Basic Information
| Provider Information | |||||||||
| NPI: | 1104981224 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DUFFEY | ||||||||
| FirstName: | KRISTY | ||||||||
| MiddleName: | O'DELL | ||||||||
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| Credential: | N.P. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8906 WINGED FOOT DR | ||||||||
| Address2: | |||||||||
| City: | PASADENA | ||||||||
| State: | MD | ||||||||
| PostalCode: | 211226670 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4103605140 | ||||||||
| FaxNumber: | 4103793591 | ||||||||
| Practice Location | |||||||||
| Address1: | 6085 MARSHALEE DR | ||||||||
| Address2: | |||||||||
| City: | ELKRIDGE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210756023 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4103793528 | ||||||||
| FaxNumber: | 4103793591 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/27/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LG0600X | R128753 | MD | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Gerontology | 363LG0600X | LD-0000115 | DE | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Gerontology | 363LG0600X | RN1006277 | DC | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Gerontology |
No ID Information.