Healthcare Provider Details

I. General information

NPI: 1235056474
Provider Name (Legal Business Name): KRYSTAL ANN COWAN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2026
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1520 W 12TH ST
RENO NV
89503-2403
US

IV. Provider business mailing address

1520 W 12TH ST
RENO NV
89503-2403
US

V. Phone/Fax

Practice location:
  • Phone: 956-329-8755
  • Fax:
Mailing address:
  • Phone: 956-329-8755
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number868513
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: