MEDICARE: CRYSTA PHIPPS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1164374112
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRYSTA PHIPPS

Provider Business Mailing Address
First Line	:	208 4TH ST E
Second Line	:
City	:	SOUTH POINT
State	:	OH
Zip	:	45680-9430
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	208 4TH ST E
Second Line	:
City	:	SOUTH POINT
State	:	OH
Zip	:	45680-9430
Country	:	US
Telephone Number	:	740-451-0307
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/12/2026
Last Update Date	:	02/12/2026

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Directions to “ CRYSTA PHIPPS ” Practice Location

Language	Start Address	Practice Location

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