Healthcare Provider Details

I. General information

NPI: 1811527492
Provider Name (Legal Business Name): CRYSTAL ALLEN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CRISTIE ALLEN

II. Dates (important events)

Enumeration Date: 01/22/2020
Last Update Date: 01/23/2020
Certification Date: 01/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 HOSPITAL CIR STE A
BATESVILLE AR
72501-7343
US

IV. Provider business mailing address

16 HOSPITAL CIR STE A
BATESVILLE AR
72501-7343
US

V. Phone/Fax

Practice location:
  • Phone: 870-793-7519
  • Fax: 870-793-8146
Mailing address:
  • Phone: 870-793-7519
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR095526
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number123697
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: