Healthcare Provider Details

I. General information

NPI: 1568038552
Provider Name (Legal Business Name): CRYSTAL D LOVETT RN, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2021
Last Update Date: 11/07/2025
Certification Date: 11/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 GROSSCUP AVE UNIT 822
DUNBAR WV
25064-4239
US

IV. Provider business mailing address

1201 GROSSCUP AVE UNIT 822
DUNBAR WV
25064-4239
US

V. Phone/Fax

Practice location:
  • Phone: 304-988-5905
  • Fax:
Mailing address:
  • Phone: 304-988-5905
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WM0102X
TaxonomyMaternal Newborn Registered Nurse
License Number83613
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code163WP1700X
TaxonomyPerinatal Registered Nurse
License Number83613
License Number StateWV
# 4
Primary TaxonomyN
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number83613
License Number StateWV
# 5
Primary TaxonomyN
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number83613
License Number StateWV
# 6
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number83613
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: