Healthcare Provider Details

I. General information

NPI: 1003744665
Provider Name (Legal Business Name): CRYSTAL SLOAN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2026
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 N CANAL ST STE A
CARLSBAD NM
88220-5876
US

IV. Provider business mailing address

6688 N CENTRAL EXPY STE 1300
DALLAS TX
75206-3950
US

V. Phone/Fax

Practice location:
  • Phone: 575-236-4844
  • Fax: 575-449-3220
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR44558
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: