Healthcare Provider Details

I. General information

NPI: 1144795865
Provider Name (Legal Business Name): CRYSTAL PARSON ROBERTS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2018
Last Update Date: 09/12/2022
Certification Date: 09/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 NEW WAVERLY PL STE 200
CARY NC
27518-7414
US

IV. Provider business mailing address

PO BOX 18563
RALEIGH NC
27619-8563
US

V. Phone/Fax

Practice location:
  • Phone: 919-859-5955
  • Fax: 919-859-5659
Mailing address:
  • Phone: 919-782-1806
  • Fax: 919-782-4756

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number0010-08525
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: