Healthcare Provider Details

I. General information

NPI: 1285660712
Provider Name (Legal Business Name): NATALIE CRYSTAL ENABNIT PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2006
Last Update Date: 09/14/2023
Certification Date: 09/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6205 43RD ST
LUBBOCK TX
79407-3828
US

IV. Provider business mailing address

12402 SLIDE RD STE 402
LUBBOCK TX
79424-8322
US

V. Phone/Fax

Practice location:
  • Phone: 806-749-2263
  • Fax: 806-749-2264
Mailing address:
  • Phone: 806-544-9248
  • Fax: 806-642-0042

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA04264
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: