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NPI Code Detail

MEDICARE: CRYSTAL CALDWELL FNP-C

MEDICARE: CRYSTAL CALDWELL FNP-C
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 Practitioner4996409-8900UT
2363LF0000XFamily Nurse Practitioner4996409-4405UT

General Provider Information

NPI Number : 1871306621
Entity Type Code : Individual
Provider Name (Legal Business Name) : CRYSTAL CALDWELL FNP-C
Provider Business Mailing Address
First Line : 1309 COFFEEN AVE STE 1200
Second Line :
City : SHERIDAN
State : WY
Zip : 82801-5777
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3435 E PONY EXPRESS PKWY STE 140
Second Line :
City : EAGLE MOUNTAIN
State : UT
Zip : 84005-5548
Country : US
Telephone Number : 801-210-0808
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/27/2025
Last Update Date : 01/27/2025

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Directions to “ CRYSTAL CALDWELL FNP-C” Practice Location

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