Healthcare Provider Details

I. General information

NPI: 1952017667
Provider Name (Legal Business Name): CRYSTAL BARTLETT COWART MSN, APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/25/2023
Last Update Date: 02/12/2023
Certification Date: 02/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2701 MEREDYTH DR
ALBANY GA
31707-2267
US

IV. Provider business mailing address

972 GA HIGHWAY 41
SHELLMAN GA
39886-4018
US

V. Phone/Fax

Practice location:
  • Phone: 229-883-7010
  • Fax:
Mailing address:
  • Phone: 770-468-5426
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN205501
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN205501
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: