Healthcare Provider Details

I. General information

NPI: 1063965978
Provider Name (Legal Business Name): CRYSTAL ADODO ORAMADIKE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2016
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

698 FAIRVIEW RD
SIMPSONVILLE SC
29680-6708
US

IV. Provider business mailing address

7513 HAWK CREST DR
FULSHEAR TX
77441-2560
US

V. Phone/Fax

Practice location:
  • Phone: 866-389-2727
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP131092
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP030382
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number283632
License Number StateAZ
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024186614
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: