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General NPI Number Information
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NPI Number | 1992385611
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Entity Type | Individual
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Provider Name | CRYSTAL LEANN LUTTRELL NP
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Gender | Female
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Dates
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Enumeration Date | 04/08/2021
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Last Update Date | 09/27/2021
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Provider Practice Location Address
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Address Line | 90 STONEGATE CTR
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City | SOMERSET
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State | KY
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Zip | 42501-6212
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Country | US
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Telephone | 606-451-4425
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Fax |
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Provider Business Mailing Address
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Address Line | 2620 ELM HILL PIKE
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City | NASHVILLE
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State | TN
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Zip | 37214-3108
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Country | US
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Telephone |
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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 | 3015993
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License Number State | KY
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