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General NPI Number Information
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NPI Number | 1275869950
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Entity Type | Individual
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Provider Name | CRYSTAL HOWELL MARTIN C-FNP
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Gender | Female
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Dates
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Enumeration Date | 10/30/2009
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Last Update Date | 11/10/2015
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Provider Practice Location Address
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Address Line | 407 S VALLEY ST
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City | CARTHAGE
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State | MS
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Zip | 39051-4051
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Country | US
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Telephone | 601-298-0333
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Fax | 601-298-0797
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Provider Business Mailing Address
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Address Line | 4134 HIGHWAY 471
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City | BRANDON
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State | MS
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Zip | 39047-8626
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Country | US
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Telephone | 601-405-3100
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | R872575
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License Number State | MS
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