Healthcare Provider Details

I. General information

NPI: 1982246443
Provider Name (Legal Business Name): CRYSTAL BARMER AGPCNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2019
Last Update Date: 05/18/2022
Certification Date: 05/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 E STONER AVE
SHREVEPORT LA
71101-4243
US

IV. Provider business mailing address

221 DECATUR ST
BOSSIER CITY LA
71111-6259
US

V. Phone/Fax

Practice location:
  • Phone: 318-990-5248
  • Fax:
Mailing address:
  • Phone: 318-286-4017
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number222025
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number110627
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: