Healthcare Provider Details

I. General information

NPI: 1982578647
Provider Name (Legal Business Name): CRYSTAL PARKER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2025
Last Update Date: 06/28/2026
Certification Date: 06/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

312 W MILLBROOK RD STE 137
RALEIGH NC
27609-4398
US

IV. Provider business mailing address

2920 FORESTVILLE RD STE 100-1082
RALEIGH NC
27616-8774
US

V. Phone/Fax

Practice location:
  • Phone: 984-325-6143
  • Fax: 984-220-9432
Mailing address:
  • Phone: 984-325-6143
  • Fax: 984-220-9432

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number1218358
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number0024195545
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number5023226
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number5023226
License Number StateNC
# 5
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number5023226
License Number StateNC
# 6
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number5023226
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: