Provider Demographics
NPI:1730894197
Name:ECKERT, KRISTIE LYNN (FNP-C)
Entity type:Individual
Prefix:
First Name:KRISTIE
Middle Name:LYNN
Last Name:ECKERT
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6201 GREENLEIGH AVE
Mailing Address - Street 2:
Mailing Address - City:MIDDLE RIVER
Mailing Address - State:MD
Mailing Address - Zip Code:21220-2004
Mailing Address - Country:US
Mailing Address - Phone:410-933-6423
Mailing Address - Fax:410-500-4266
Practice Address - Street 1:301 ST PAUL ST
Practice Address - Street 2:MCAULEY SUITE 718
Practice Address - City:BALTIMORE MD
Practice Address - State:MD
Practice Address - Zip Code:21202-2165
Practice Address - Country:US
Practice Address - Phone:410-332-9356
Practice Address - Fax:410-659-1162
Is Sole Proprietor?:No
Enumeration Date:2023-01-19
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDR195409363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner