Healthcare Provider Details

I. General information

NPI: 1487811527
Provider Name (Legal Business Name): CRYSTAL WILLIAMS NOCK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2008
Last Update Date: 03/19/2024
Certification Date: 03/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3080 COLLEGE ST
BEAUMONT TX
77701-4606
US

IV. Provider business mailing address

9301 S WESTERN AVE
OKLAHOMA CITY OK
73139-2728
US

V. Phone/Fax

Practice location:
  • Phone: 409-212-5000
  • Fax:
Mailing address:
  • Phone: 866-321-8433
  • Fax: 405-321-4603

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number35.148682
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberU6541
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: