Healthcare Provider Details

I. General information

NPI: 1275447229
Provider Name (Legal Business Name): CRYSTAL GAIL LEEK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26064 SHORTLINE HWY
SMITHFIELD WV
26437-8657
US

IV. Provider business mailing address

26064 SHORTLINE HWY
SMITHFIELD WV
26437-8657
US

V. Phone/Fax

Practice location:
  • Phone: 304-815-4373
  • Fax:
Mailing address:
  • Phone: 304-815-4373
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: