Healthcare Provider Details

I. General information

NPI: 1245000975
Provider Name (Legal Business Name): CRYSTAL DARMIKA WHITE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/04/2024
Last Update Date: 02/04/2026
Certification Date: 02/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3035 BRINKLEY RD APT 201
TEMPLE HILLS MD
20748-6150
US

IV. Provider business mailing address

6503 ASSET DR
HYATTSVILLE MD
20785-5834
US

V. Phone/Fax

Practice location:
  • Phone: 240-353-9181
  • Fax:
Mailing address:
  • Phone: 240-353-9181
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR235444
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: