1215565460 NPI number — CRYSTAL PARKER MCQUISTON RN

Table of content: CRYSTAL PARKER MCQUISTON RN (NPI 1215565460)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215565460 NPI number — CRYSTAL PARKER MCQUISTON RN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCQUISTON
Provider First Name:
CRYSTAL
Provider Middle Name:
PARKER
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PARKER
Provider Other First Name:
CRYSTAL
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
RN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1215565460
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/04/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
712 SPRINGTIME BLVD SW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HUNTSVILLE
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35802-5107
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
256-550-0131
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
THE COVERY WELLNESS SPA
Provider Second Line Business Practice Location Address:
2319 MEMORIAL PKWY SUITE 115
Provider Business Practice Location Address City Name:
HUNTSVILLE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35801
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-489-6365
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/31/2020

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: 163W00000X , with the licence number:  1-151057 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 390200000X , with the licence number: 1-151057 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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