Healthcare Provider Details

I. General information

NPI: 1730787599
Provider Name (Legal Business Name): CRYSTAL NEAL NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2020
Last Update Date: 01/29/2026
Certification Date: 01/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7900 W JEFFERSON BLVD STE 201
FORT WAYNE IN
46804-4128
US

IV. Provider business mailing address

6920 POINTE INVERNESS WAY
FORT WAYNE IN
46804-7938
US

V. Phone/Fax

Practice location:
  • Phone: 260-969-7191
  • Fax: 260-969-7253
Mailing address:
  • Phone: 260-479-3514
  • Fax: 260-479-3520

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71011624A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number28222257A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: