Healthcare Provider Details

I. General information

NPI: 1649135633
Provider Name (Legal Business Name): CRYSTAL REPLOGLE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2025
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1513 HARRISON AVE STE A12
ELKINS WV
26241-3356
US

IV. Provider business mailing address

137 S FLORIDA ST
BUCKHANNON WV
26201-2557
US

V. Phone/Fax

Practice location:
  • Phone: 304-553-7063
  • Fax:
Mailing address:
  • Phone: 304-203-9055
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: