Healthcare Provider Details

I. General information

NPI: 1790140549
Provider Name (Legal Business Name): CRYSTAL HILL FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2015
Last Update Date: 11/13/2024
Certification Date: 11/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

740 JUSTA ST
MORGAN CITY LA
70380-1513
US

IV. Provider business mailing address

109 BAYOU BEND DR
HOUMA LA
70364-1168
US

V. Phone/Fax

Practice location:
  • Phone: 985-384-1726
  • Fax:
Mailing address:
  • Phone: 985-217-9171
  • Fax: 985-251-2283

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP08565
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberAP08565
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: