Healthcare Provider Details

I. General information

NPI: 1730895210
Provider Name (Legal Business Name): CRYSTAL EDWARDS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2023
Last Update Date: 09/20/2024
Certification Date: 09/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4460 PERKINS ROAD
BATON ROUGE LA
70808
US

IV. Provider business mailing address

5800 ONE PERKINS PLACE DR STE A
BATON ROUGE LA
70808-9113
US

V. Phone/Fax

Practice location:
  • Phone: 225-224-8690
  • Fax:
Mailing address:
  • Phone: 225-224-8690
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number228783
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number228783
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: