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

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 and National Provider Directory roles.

• Azam Baig,M.D.

  • 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
• Chelsea Hayes Thompson, MD
• Vivienne Frances Thompson, MS CCC-SLP
• Toller Enterprises LLC
• Taryn Toman, LCSW-C
• Tsvetomila Tonova
• Sue Katherine Topcuoglu, LCPC
• Heidi Tracey, MA, CAS, LGPC, NCSP

• All providers in Edgewater, MD
• 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.