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NPI Code Detail

MEDICARE: CRYSTELLE LEEELLEN CARMACK CRNP

MEDICARE:   CRYSTELLE LEEELLEN CARMACK  CRNP
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
1363LF0000XFamily Nurse Practitioner5021315NC
2363LF0000XFamily Nurse Practitioner27084SC
3363LF0000XFamily Nurse Practitioner231008AR
4363LF0000XFamily Nurse Practitioner2024046764MO
5363LF0000XFamily Nurse PractitionerAP4444AZ
6363LF0000XFamily Nurse Practitioner31680TN
7363LF0000XFamily Nurse PractitionerAPRN-5064HI
8363LF0000XFamily Nurse Practitioner1-109160AL
9363L00000XNurse PractitionerSP032000PA
10363LF0000XFamily Nurse PractitionerSP032000PA
11363LF0000XFamily Nurse Practitioner71016301AIN
12363LF0000XFamily Nurse PractitionerAPRN11022060FL
13363LF0000XFamily Nurse PractitionerAPRN.CNP.0034762OH
14363LF0000XFamily Nurse Practitioner907103MS
15363LF0000XFamily Nurse Practitioner209027339IL

General Provider Information

NPI Number : 1295031169
Entity Type Code : Individual
Provider Name (Legal Business Name) : CRYSTELLE LEEELLEN CARMACK CRNP
Provider Business Mailing Address
First Line : PO BOX 211699
Second Line :
City : EAGAN
State : MN
Zip : 55121-3699
Country : US
Telephone Number : 866-849-0692
Fax Number : 888-973-8821
Provider Business Practice Location Address
First Line : 1 PERIMETER PARK S STE 100N
Second Line :
City : BIRMINGHAM
State : AL
Zip : 35243-3248
Country : US
Telephone Number : 866-849-0692
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/09/2011
Last Update Date : 10/09/2025

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Directions to “ CRYSTELLE LEEELLEN CARMACK CRNP” Practice Location

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