Healthcare Provider Details

I. General information

NPI: 1356077275
Provider Name (Legal Business Name): CRYSTAL ANN MAY PRSS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2022
Last Update Date: 02/07/2024
Certification Date: 02/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 MEDICAL CENTER DR
HUNTINGTON WV
25701-3656
US

IV. Provider business mailing address

1804 KITE AVE
HUNTINGTON WV
25701-4214
US

V. Phone/Fax

Practice location:
  • Phone: 304-696-8700
  • Fax: 304-696-8701
Mailing address:
  • Phone: 681-294-0500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number21-9111
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: