Healthcare Provider Details

I. General information

NPI: 1609225101
Provider Name (Legal Business Name): JHASMUN CRUTCHER FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2016
Last Update Date: 06/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2909 S HAMPTON RD SUITE 107
DALLAS TX
75224-3000
US

IV. Provider business mailing address

2909 S HAMPTON RD SUITE 107
DALLAS TX
75224-3000
US

V. Phone/Fax

Practice location:
  • Phone: 214-467-3832
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP131037
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: