Healthcare Provider Details

I. General information

NPI: 1275869950
Provider Name (Legal Business Name): CRYSTAL HOWELL MARTIN C-FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS CRYSTAL LEIGH HOWELL

II. Dates (important events)

Enumeration Date: 10/30/2009
Last Update Date: 11/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

407 S VALLEY ST
CARTHAGE MS
39051-4051
US

IV. Provider business mailing address

4134 HIGHWAY 471
BRANDON MS
39047-8626
US

V. Phone/Fax

Practice location:
  • Phone: 601-298-0333
  • Fax: 601-298-0797
Mailing address:
  • Phone: 601-405-3100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR872575
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: