Krystal Veronica Tibbs, CPNP

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

RO93983 Issued in MD

Practice address

224 Mayo Rd Ste a
Edgewater, MD 21037-2951

Phone

(301) 956-6303

NPI assigned

Oct 16, 2007

Last updated

Sep 7, 2023By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Krystal Tibbs Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Certified Pediatric Nurse Practitioner, Nurse Practitioner

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: krichardson@southriverpediatrics.opdirect.net

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Azam Baig,M.D.

  dba South River Pediatrics

  • Primary Care Clinic/Center
  • Edgewater, MD
  • NPI 1124123716
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1192492800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1694044800000",
    "number": "1437348463",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "224 MAYO RD STE A",
            "city": "EDGEWATER",
            "state": "MD",
            "postal_code": "210372951",
            "telephone_number": "410-956-6303"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "224 MAYO RD STE A",
            "city": "EDGEWATER",
            "state": "MD",
            "postal_code": "210372951",
            "telephone_number": "301-956-6303"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TIBBS",
        "first_name": "KRYSTAL",
        "middle_name": "VERONICA",
        "credential": "CPNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-10-16",
        "last_updated": "2023-09-07",
        "certification_date": "2023-09-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MD",
            "license": "RO93983",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KRYSTAL",
            "last_name": "TIBBS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Cynthia Michelle Tawney, ADT 2421
• Jaime C Taylor, PAC
• Thi of Maryland at South River LLC (South River Health and Rehabilitation Center)
• Chelsea Hayes Thompson, MD
• Vivienne Frances Thompson, MS CCC-SLP
• Toller Enterprises LLC
• Taryn Toman, LCSW-C
• Tsvetomila Tonova
• Suzan Katherine Topcuoglu, LCPC
• Heidi Tracey, MA, CAS, LGPC, NCSP

• Nurse Practitioner in Edgewater, MD
• Providers in Edgewater, MD by specialty
• Nurse Practitioner in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.