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Individual

MS. KRISTY MICHELLE FOGLE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA-C

Contact information

Practice address
5401 OLD COURT ROAD, NORTHWEST HOSPITAL-EMERGENCY DEPARTMENT, RANDALLSTOWN, MD 21133
(443) 848-8705
Mailing address
31 COOLPOND CT, BALTIMORE, MD 21227-3839
(443) 848-8705

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
C0005156
MD
363AM0700X
Medical Physician Assistant
C0005156
MD

Other

Enumeration date
09/10/2013
Last updated
09/10/2013
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