Healthcare Provider Details

I. General information

NPI: 1881502409
Provider Name (Legal Business Name): KRYSTAL LUCERO MARTINEZ PMH-NP BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

295 CHESTNUT RIDGE DR
KUNKLETOWN PA
18058-7165
US

IV. Provider business mailing address

490 KUNKLETOWN RD PO BOX 269
KUNKLETOWN PA
18058-7165
US

V. Phone/Fax

Practice location:
  • Phone: 806-500-3900
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberSP037022
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: