1780132241 NPI number — MRS. CRYSTAL JOHNSON CRUTCHFIELD FNP

Table of content: MRS. CRYSTAL JOHNSON CRUTCHFIELD FNP (NPI 1780132241)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780132241 NPI number — MRS. CRYSTAL JOHNSON CRUTCHFIELD FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CRUTCHFIELD
Provider First Name:
CRYSTAL
Provider Middle Name:
JOHNSON
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
FNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1780132241
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/13/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6031 HICKORY LINCOLNTON HWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LINCOLNTON
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28092-6819
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-473-6429
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
810 FAIRGROVE CHURCH RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HICKORY
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28602-9617
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-326-3855
Provider Business Practice Location Address Fax Number:
828-326-2717
Provider Enumeration Date:
09/13/2016

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  5008908 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com