MEDICARE: CRYSTAL BOKORNEY NP

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	363L00000X	Nurse Practitioner	1036649	TX

General Provider Information

NPI Number	:	1831773548
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRYSTAL BOKORNEY NP

Provider Business Mailing Address
First Line	:	111 ROCKY COVE LN
Second Line	:
City	:	DICKINSON
State	:	TX
Zip	:	77539-3221
Country	:	US
Telephone Number	:	920-918-8982
Fax Number	:

Provider Business Practice Location Address
First Line	:	6807 EMMETT F LOWRY EXPY STE 108
Second Line	:
City	:	TEXAS CITY
State	:	TX
Zip	:	77591-2547
Country	:	US
Telephone Number	:	409-945-5444
Fax Number	:

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

Provider Enumeration Date	:	05/09/2021
Last Update Date	:	05/09/2021

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Directions to “ CRYSTAL BOKORNEY NP” Practice Location

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