Healthcare Provider Details

I. General information

NPI: 1730903535
Provider Name (Legal Business Name): CRYSTAL BYRD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/09/2024
Last Update Date: 11/09/2024
Certification Date: 11/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5105 E MAIN ST
COLUMBUS OH
43213-2410
US

IV. Provider business mailing address

PO BOX 307468
COLUMBUS OH
43230-7468
US

V. Phone/Fax

Practice location:
  • Phone: 614-273-9649
  • Fax: 614-626-4064
Mailing address:
  • Phone: 614-273-9649
  • Fax: 614-626-4064

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: