NPIMap

Individual provider Active NPI

Kristen Elaine Black, CRNP

  • Gerontology Nurse Practitioner
  • Hagerstown, MD
National Provider Identifier
1730767302
Registry record updated Nov 4, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gerontology Nurse PractitionerTaxonomy code 363LG0600X
License
R209202 Issued in MD
Practice address
354 Mill St
Hagerstown, MD 21740-6138
Phone
(301) 797-0210
NPI assigned
Apr 1, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 4, 2025

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Gerontology Nurse Practitioner 363LG0600X R209202 MD Primary
Gerontology Nurse Practitioner 363LG0600X SP023459 PA
Gerontology Nurse Practitioner 363LG0600X RN706137 MD

Addresses

Primary practice location

354 Mill St
Hagerstown, MD 21740-6138

Mailing address

354 Mill St
Hagerstown, MD 21740-6138
Phone (301) 676-0160

Other names 1

  • Kristen Elaine Kelly Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240418003202 MD Practitioner - Nurse Practitioner 8426440306 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Meritus Medical Center IncGroup PAC ID 7113811795, 730 clinicians
Primary Care Associates of Hagerstown, LLCGroup PAC ID 2264620558, 3 clinicians

Practice addresses (Care Compare)

11110 Medical Campus Rd
Hagerstown, MD 21742-6700

354 Mill St
Hagerstown, MD 21740-6138
Phone (301) 797-0210

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
R209202MDMDGerontology Nurse Practitioner
RN706137MDMDGerontology Nurse Practitioner
SP023459PAMDGerontology Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Primary Care Associates of Hagerstown, LLC CurrentSince May 1, 2024 Accepting new patients
Frederick Health Hospital Inc Past Accepting new patients
Meritus Medical Laboratory LLC Past Accepting new patients

Locations

354 Mill St
Hagerstown, MD 21740
Phone (301) 739-7360

Organizations & group practices 11

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.

NPI Registry JSON

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

{
    "created_epoch": "1617235200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1762214400000",
    "number": "1730767302",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "354 MILL ST",
            "city": "HAGERSTOWN",
            "state": "MD",
            "postal_code": "217406138",
            "telephone_number": "301-676-0160"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "354 MILL ST",
            "city": "HAGERSTOWN",
            "state": "MD",
            "postal_code": "217406138",
            "telephone_number": "301-797-0210"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACK",
        "first_name": "KRISTEN",
        "middle_name": "ELAINE",
        "credential": "CRNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-04-01",
        "last_updated": "2025-11-04",
        "certification_date": "2025-11-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "MD",
            "license": "R209202",
            "primary": true
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "PA",
            "license": "SP023459",
            "primary": false
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "MD",
            "license": "RN706137",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KRISTEN",
            "last_name": "KELLY",
            "middle_name": "ELAINE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Hagerstown, MD

Sources for this page

Verify at the official NPI Registry.