Healthcare Provider Details

I. General information

NPI: 1073184396
Provider Name (Legal Business Name): CRYSTAL MARIE HAYES APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CRYSTAL KOLLING

II. Dates (important events)

Enumeration Date: 07/07/2021
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3817 MAIN ST
LORIS SC
29569-3017
US

IV. Provider business mailing address

PO BOX 547
FAISON NC
28341-0547
US

V. Phone/Fax

Practice location:
  • Phone: 843-663-8000
  • Fax:
Mailing address:
  • Phone: 843-663-8000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26579
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5020044
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: