Healthcare Provider Details

I. General information

NPI: 1174459606
Provider Name (Legal Business Name): CRYSTAL EVANS PERRY AGNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/22/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MARION MEDICAL CENTER 2829 EAST HIGHWAY 76
MULLINS SC
29574
US

IV. Provider business mailing address

MARION MEDICAL CENTER 2829 EAST HIGHWAY 76
MULLINS SC
29574
US

V. Phone/Fax

Practice location:
  • Phone: 843-431-2000
  • Fax:
Mailing address:
  • Phone: 843-431-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number32005
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: