Healthcare Provider Details

I. General information

NPI: 1598214629
Provider Name (Legal Business Name): CRYSTAL WEST WOODS M.S., R.D.N., L.D.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MS. CRYSTAL WEST

II. Dates (important events)

Enumeration Date: 09/30/2016
Last Update Date: 12/01/2021
Certification Date: 09/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

924 PROSPECT AVE
BRISTOL VA
24201-3462
US

IV. Provider business mailing address

924 PROSPECT AVE
BRISTOL VA
24201-3462
US

V. Phone/Fax

Practice location:
  • Phone: 276-791-0543
  • Fax:
Mailing address:
  • Phone: 276-791-0543
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number0000002868
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: