Provider Demographics
NPI:1609614304
Name:JOHAL, KRISTY (CRNP PMHNP-BC)
Entity type:Individual
Prefix:
First Name:KRISTY
Middle Name:
Last Name:JOHAL
Suffix:
Gender:F
Credentials:CRNP PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1850 BUCK HILL DR
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17408-7626
Mailing Address - Country:US
Mailing Address - Phone:443-694-1849
Mailing Address - Fax:
Practice Address - Street 1:3000 MANCHESTER RD STE B
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:MD
Practice Address - Zip Code:21102-1850
Practice Address - Country:US
Practice Address - Phone:410-861-0066
Practice Address - Fax:410-348-7865
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-17
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR187057363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health