Healthcare Provider Details

I. General information

NPI: 1356965958
Provider Name (Legal Business Name): CRYSTAL DORRELL FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/31/2020
Last Update Date: 05/31/2020
Certification Date: 05/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

735 N 5TH ST
SILSBEE TX
77656-3838
US

IV. Provider business mailing address

735 N 5TH ST
SILSBEE TX
77656-3838
US

V. Phone/Fax

Practice location:
  • Phone: 409-385-6500
  • Fax:
Mailing address:
  • Phone: 409-385-6500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP145067
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: