Healthcare Provider Details

I. General information

NPI: 1013162981
Provider Name (Legal Business Name): CRYSTAL C HUFFAKER FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CRYSTAL C JOHNSON FNP

II. Dates (important events)

Enumeration Date: 11/19/2008
Last Update Date: 09/02/2025
Certification Date: 09/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1055 N 500 W STE 211, BUILDING C
PROVO UT
84604-3305
US

IV. Provider business mailing address

1055 N 500 W ATT CREDENTIALING
PROVO UT
84604-3305
US

V. Phone/Fax

Practice location:
  • Phone: 801-357-7327
  • Fax: 801-375-8860
Mailing address:
  • Phone: 801-354-8225
  • Fax: 801-418-0941

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP-1418A
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN001888
License Number StateNV
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5903703-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: