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General NPI Number Information
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NPI Number | 1316149628
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Entity Type | Individual
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Provider Name | CRYSTAL LYNNIA BROADNAX MSN, RN
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Gender | Female
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Dates
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Enumeration Date | 05/31/2007
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 4101 S 4TH ST
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City | LEAVENWORTH
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State | KS
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Zip | 66048-5014
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Country | US
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Telephone | 913-682-2000
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Fax |
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Provider Business Mailing Address
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Address Line | 4 BUCKNER AVE
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City | FORT LEAVENWORTH
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State | KS
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Zip | 66027-1208
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Country | US
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Telephone | 913-297-0193
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 14-97827-091
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License Number State | KS
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Taxonomy #2
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Taxonomy Code | 163WC0400X
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Taxonomy Name | Case Management Registered Nurse
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License Number | 14-97827-091
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License Number State | KS
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Taxonomy #3
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Taxonomy Code | 163WE0003X
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Taxonomy Name | Emergency Registered Nurse
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License Number | 14-97827-091
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License Number State | KS
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Taxonomy #4
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Taxonomy Code | 163WG0000X
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Taxonomy Name | General Practice Registered Nurse
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License Number | 14-97827-091
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License Number State | KS
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Taxonomy #5
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Taxonomy Code | 163WP2201X
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Taxonomy Name | Ambulatory Care Registered Nurse
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License Number | 14-97827-091
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License Number State | KS
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