Healthcare Provider Details

I. General information

NPI: 1639549371
Provider Name (Legal Business Name): CRYSTAL HURST FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CRYSTAL LENEE JOHNSON FNP

II. Dates (important events)

Enumeration Date: 10/06/2015
Last Update Date: 10/03/2024
Certification Date: 10/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 HOSPITAL RD
NEW ROADS LA
70760-2630
US

IV. Provider business mailing address

725 HOSPITAL RD
NEW ROADS LA
70760-2630
US

V. Phone/Fax

Practice location:
  • Phone: 373-912-4030
  • Fax:
Mailing address:
  • Phone: 373-912-4030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP08429
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: