NPIMap

Individual provider Active NPI

Mary Kristen Shytle, CRNP

  • Adult Health Nurse Practitioner
  • Rockville, MD
National Provider Identifier
1992138598
Registry record updated Mar 12, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
R207510 Issued in MD
Practice address
10110 Molecular Drive
Suite #206
Rockville, MD 20850
Phone
(301) 279-2779
Fax
(240) 403-0190
NPI assigned
Aug 19, 2013
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 12, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Nurse Practitioner 363LA2200X R207510 MD Primary

Addresses

Primary practice location

10110 Molecular Drive
Suite #206
Rockville, MD 20850

Mailing address

10110 Molecular Drive
Suite #206
Rockville, MD 20850
Phone (301) 279-2779

Other names 1

  • Mary Kristen Johnson Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
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
I20201022002435 NC Practitioner - Nurse Practitioner 3577798131 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Duke University Health System, IncGroup PAC ID 2567372345, 1,083 clinicians

Practice addresses (Care Compare)

3400 Wake Forest Rd
Raleigh, NC 27609-7317
Phone (919) 954-3965

Hospital & facility affiliations

  • Duke Home Health Home health agency, Durham, NC, CCN 347136
  • Medi Home Health Agency Home health agency, Raleigh, NC, CCN 347237
  • Duke University Hospital Hospital, Durham, NC, CCN 340030
  • Wakemed, Raleigh Campus Hospital, Raleigh, NC, CCN 340069

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
R207510MDMDAdult Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Duke University Health System, Inc. CurrentSince Jul 21, 2020 Accepting new patients
Duke University Health System, Inc. CurrentSince Jul 21, 2020 Accepting new patients
Duke University Health System, Inc. Nurse Practitioner Current Accepting new patients

Locations

5213 S Alston Ave
Durham, NC 27713
Phone (919) 620-4700

3320 Wake Forest Rd
Raleigh, NC 27609
Phone (919) 790-1717

3400 Wake Forest Rd
Raleigh, NC 27609
Phone (919) 954-3000

Organizations & group practices 3

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.

Hospital & facility affiliations 10

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1376870400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1583971200000",
    "number": "1992138598",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10110 MOLECULAR DRIVE",
            "address_2": "SUITE #206",
            "city": "ROCKVILLE",
            "state": "MD",
            "postal_code": "20850",
            "telephone_number": "301-279-2779",
            "fax_number": "240-238-8988"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10110 MOLECULAR DRIVE",
            "address_2": "SUITE #206",
            "city": "ROCKVILLE",
            "state": "MD",
            "postal_code": "20850",
            "telephone_number": "301-279-2779",
            "fax_number": "240-403-0190"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHYTLE",
        "first_name": "MARY",
        "middle_name": "KRISTEN",
        "name_prefix": "Ms.",
        "credential": "CRNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-08-19",
        "last_updated": "2020-03-12",
        "certification_date": "2020-03-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "MD",
            "license": "R207510",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARY",
            "last_name": "JOHNSON",
            "middle_name": "KRISTEN",
            "credential": "CRNP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Rockville, MD

Sources for this page

Verify at the official NPI Registry.