MEDICARE: CRYSTAL HOWARD RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	133046	TN

General Provider Information

NPI Number	:	1013614601
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRYSTAL HOWARD RN

Provider Business Mailing Address
First Line	:	9108 JOY LN
Second Line	:
City	:	OAK RIDGE
State	:	TN
Zip	:	37830-3532
Country	:	US
Telephone Number	:	865-924-9432
Fax Number	:

Provider Business Practice Location Address
First Line	:	9108 JOY LN
Second Line	:
City	:	OAK RIDGE
State	:	TN
Zip	:	37830-3532
Country	:	US
Telephone Number	:	865-924-9432
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/14/2023
Last Update Date	:	02/14/2023

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